Help with Apgar Scoring

Specialties Ob/Gyn

Published

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.

Memphis

Isnt that SOOOO frustrating??

I had a similar situation, however, I had no bag/mask and no O2 tubing for blowby. I listened and listened and listened while urgently telling the OB nurse that I needed the stuff stat. I had a good HR, but there were NO (I repeat NO) breath sounds. There was no chestrise and no breath sounds. For some reason, the baby was pinking up. But still no breath sounds. At one minute the baby was still a bit cyanotic so I gave a 2. The OB attending was at the bedside and said the baby must be fine, he was pinkind up. I offered him the stethescope and as soon as he put them in his ears the baby took a nice big breath and started breathing. He looked up at me and said "He has breath sounds." WAell, he also had chestrise, so what do you conclude from that?? I assume he didnt have breath sounds if he had NO chest rise!!! (plus I listened so I knopw my assumption was right!)

He got into a huge argument with me when he was at the desk asking apgars. I told him it was my call, so discussion over.

There is a reason the person doing the delivery doesnt assign apgars!!!

Hi! I'm 3 months new to L&D and this is probably a stupid question, but I am going to ask anyway :) As far as apgars are concerned, when the doc puts baby on mom's belly right after delivery, how am I supposed to get an accurate apgar when the baby is wrapped in a blanket most of the time facing mom. This whole process freaks me out. Partly because I dont want to get in the way of the mom/baby moment but I know that I have a job to do to make sure baby is okay. Do you feel the cord and just check for a fast pulse or do you actually count for 6 seconds and to me sometimes the baby looks blue but nobody else seems to react so when do you know to take baby off the belly and when baby is probably okay to stay. When I assigned my first apgar for the first time, I really felt like I was just guessing. Baby had a good cry, looked pink with acrocyanotic hands and feet, active, couldnt really assess tone too well so gave it a 9. EEEKKKK!! Any advice??

I was taught that if baby is actively crying, you can assume HR is >100. Even if baby looks a little blue, I will not interfere with mom/baby bonding as long as it is crying. If not crying and won't cry when I'm stimulating it, I will go ahead and take baby for a bit so I can make sure it's OK.

tapple . .. Hi - in answer to your question, I'm standing at the mom's side and I'm rubbing the baby with a blanket to dry the baby off and I switch out the wet blankets for dry ones so I can get a good look at the baby then . . . and I listen to the heart with my stethoscope, which is around my neck prior to delivery . . .I'm right there in the middle of the delivery so I have complete access to the baby, even if the baby is on the mom's chest and they are bonding.

I'm not sure why you can't get access to the baby.

steph

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