Factors Affecting the Differentiation of The Apgar Score and The Biochemical Correlation of Fetal Well-being – a Prospective Observational Clinical Study

OBJECTIVE: The purpose of the study was to identify the features of both the labor and the assisting physicians when evaluating the newborn according to the Apgar score and how these correlate with the biochemical markers of fetal well-being in order to make the Apgar score more objective. MATERIAL AND METHODS: A prospective observational clinical study conducted in a 3(rd) reference level center between 1(st) April 2014 and 31(st) March 2015. The study enrolled 17 neonatologists and 1527 term newborns. RESULTS: The Apgar score is highest after natural vaginal delivery, lower after instrumental labor (p <0.001). The pH of the umbilical cord blood and lactate concentration correlate better with a high score than with a lowered one. The young age of a physician does not reduce Apgar score reliability. There were no differences in Apgar assessment according to physicians’ training and the time of labor. There were no correlations between abnormalities in postnatal central nervous system ultrasound and the Apgar score. CONCLUSION: Biochemical tests of umbilical cord blood significantly increase the Apgar score reliability.