APGAR Score Study Guide

APGAR Score

• APGAR score is used to assess newborn's overall health and well-being at 1 and 5 minutes after birth
• The score is based on five criteria: appearance, pulse, grimace, activity, and respiration
• Each criterion is scored from 0 to 2, with a total score ranging from 0 to 10
• A score of 7 or higher indicates that the newborn is in good condition
• A score below 7 may indicate that the newborn needs medical attention

APGAR Criteria

• Appearance:
  • 0: pale or blue
  • 1: acrocyanosis (blue hands and feet)
  • 2: normal color
• Pulse:
  • 0: no pulse
  • 1: pulse under 100
  • 2: pulse over 100
• Grimace:
  • 0: no response
  • 1: grimace in response to stimulation
  • 2: cry in response to stimulation
• Activity:
  • 0: flaccid
  • 1: minimal flexion
  • 2: strong movement
• Respiration:
  • 0: no breathing
  • 1: weak cry
  • 2: strong cry

Postpartum Hemorrhage (PPH)

• Defined as a blood loss of more than 500 mL for a vaginal delivery or more than 1000 mL for a cesarean section
• Early PPH: occurs within the first 24 hours after delivery
• Late PPH: occurs after 24 hours and up to 12 weeks postpartum
• Causes of PPH:
  • Uterine atony (failure of the uterus to contract)
  • Uterine rupture
  • Placenta previa or abruption
  • Lacerations or trauma
  • Coagulopathy
• Risk factors for PPH:
  • Prolonged labor
  • Oxytocin use
  • Multiple pregnancy
  • Uterine fibroids
  • History of PPH

Fetal Circulation and Newborn Transition

• Fetal circulation:
  • Oxygen and nutrients are received from the mother's bloodstream
  • Deoxygenated blood returns to the placenta
  • Shunts direct blood flow from the right atrium to the left atrium
• Newborn transition:
  • Initiation of respiration triggers closure of the shunts
  • Foramen ovale closes within minutes
  • Ductus arteriosus closes within hours
  • Ductus venosus takes days to close

Risks for Postpartum Infections

• Puerperal infection: any infection that occurs after delivery
• Mastitis:
  • Caused by bacteria entering the breast tissue
  • Symptoms: flu-like symptoms, fever, localized pain, and swelling
  • Treatment: antibiotics, continued breastfeeding, and supportive measures
• Endometritis:
  • Caused by bacteria entering the uterine tissue
  • Symptoms: fever, chills, malaise, and abdominal pain
  • Treatment: antibiotics and supportive measures

Newborn Reflexes

• Rooting reflex: stimulates the baby to turn towards the nipple
• Sucking reflex: stimulates the baby to suckle
• Tonic neck reflex: stimulates the baby to turn its head
• Moro reflex: stimulates the baby to extend its arms and legs

Physiologic Jaundice

• Normal, non-pathologic condition that occurs in newborns
• Caused by the breakdown of fetal hemoglobin
• Appears 2-3 days after birth and peaks at 5-7 days
• Bilirubin levels rise and fall gradually

Vitamin K

• Given to newborns to prevent bleeding due to vitamin K deficiency
• IM injection is administered to help the baby clot
• Education: teach parents that it is not a vaccine
• Reason: gut is sterile, and until good bacteria colonize, vitamin K is not synthesized

Newborn Skin Assessment

• Cyanosis: indicates respiratory depression
• Acrocyanosis: a normal finding in newborns
• Vernix caseosa: a protective substance on the skin
• Stork bites: benign, blanching, and disappear in 2 years
• Millia: caused by immature sebaceous glands, no intervention needed
• Erythema toxicum: 70% of babies have this, educate parents not to pick at it
• Harlequin sign: caused by vasomotor changes, goes away
• Nevus flammeus: permanent, non-blanchable
• Nevus vasculosus: strawberry-like mass, goes away in a couple of years

Lochia

• Rubra: bright red, 1-3 days from placental site
• Serosa: pink/brown, 4-10 days, blood and wound exudate from placenta and cervical mucosa
• Alba: white/yellow, 10-14 days up to 6 weeks, WBCs and trophoblastic tissue debris
• Normal to have moderate lochia, heavier bleeding expected after sleeping or lying down