[obnurse13]

I have worked Labor and Delivery for @ 6 years. Our department has all LDRP's and all nurses function in labor, delivery, pp and newborn care. I recently had a new grad midwife question my Apgar score on a delivery. I scored 8 and 9 apgars counting off for color. The midwife says that you can't give a 0 for color if you give a 2 for heart rate and respirations.
I count 1 for color if the infant is pink centrally w/acrocyanosis and I count a 0 for color if there is any central cyanosis (circum-oral included). I have practiced this way for my entire career and have never had anyone question my scoring. Every APGAR chart I find is unspecific, it say 0 for apperance if the infant is blue/pale, and 1 for color if pink with blue hands and feet.
My rationale is if there is any central cyanosis, it doesn't fall under the 1 category? Am I wrong? I am willing to change my practice if I can find documentation to back it. Any help will be appreciated.

[Elvish]

NRP has always preached to us that if a baby is pink, and vigorous that you can assume the HR is >100. However, I have seen many babies come into this world very pale/blue but RR>30 and HR >100. These are usually the ones that are alert but haven't cried yet, in my experience. Once they cry they pink right up and bam! another 1-2 apgar points.

You score what you see. If she were doing the apgars, she would score what she sees. I don't see as how you're doing anything wrong. JMO.

[DEB52]

That's the way I did apgars.

[Spidey's mom]

Your midwife doesn't make sense.

You score what you see. You did the right thing.

steph

[lovemyjob]

Sounds like a certain midwife is trying to make numbers look better!!

It is not uncommon for a kid to have a HR >100 and be screaming but still be blue as a goose. It has to do with transition of blood flow more so than RR and HR.

I have been told by many-a-docs that a 10/10 apgar is impossible, that fetal transition does not happen that fast.

You go right ahead and chart what you see..... it is YOUR call!!!

[SmilingBluEyes]

What the others said. Score what YOU see. And chart it that way.

[33-weeker]

Our charting system says 'centrally pink with blue extremities' = 1. Acrocyanosis is a normal newborn finding. I don't count off for that.

[crissrn27]

I have had OBs get really mad at my APGARs, especially with a bad baby. A couple have told me that this is their "report card" of how well the labor/delivery went, and who doesn't want to do well on their report card?

I read a study that said the delivering person should never give the baby Apgars, because they are always higher than they should be. I will try to find it and post it here.

I give out more 10s than a lot of the nurses I work with, but it has been very rare that I have given, or seen 10/10s. Most babies just don't transition that fast. I usually give 8 for 1 minute, counting off either 2 for color (I count central cyanosis as 2) or 1 off for color and 1 off for tone. Now, if this isn't the case I give what I see. I have given 9/10 and 10/10, but I don't think it happens often. Then again, some of the nurses I work with "knee-jerk it" and give 8/9 for all health babies.

[strn96]

I agree, chart what you see. I've never actually given a 10/10. Never had a baby that I thought deserved it. I have given a few 9/10s, and quite a few 9/9s. It is frustrating when the doctor/midwife tries to argue Apgars. After all, you're the one that's right there with the baby while they're busy attending to mom. And yes, babies can have a HR>100 and still deserve a 0 for color.

[lovemyjob]

To those who dont count acrocyanosis, although it may be a normal finding, it is still (according to NRP, the standard reference for APGAR scoring) counted as a 1. Central cyanosis at 1 min is not really such an abnormal finding either. Some kids may take longer than one minute to transition....

I assume if NRP says to count acro as a 1, then acro should be a 1. How is this less important than scoring 2 for the HR when it is not above 100? If we do apgar scoring "cafateria style," it takes away from the validity of the scoring.