Association of Natal and Maternal Risk Factors with Neonatal Apgar Score in Mosul

Background: The Apgar score is a recognized and practical way to report a newborn infant's condition at 1st and 5th minutes after birth and their reaction to resuscitation, if necessary; nonetheless, it has been improperly used to forecast specific negative neurologic outcomes.

Aim of the Study: To identify the most frequent maternal risk factors associated with low Apgar scores among newborns and evaluate the effect of neonatal sex, type of delivery, mothers’ age on Apgar score at Al-Batool Teaching Hospital in Mosul.

Methodology: This study used a cross-sectional Hospital based study design to achieve the study objectives. The data was obtained and collected from 93 maternal and neonatal record files for the mothers who delivered at Al-Batool Teaching Hospital for the period from 1st May 31st June 2023 with a simple random sampling method was used. All maternity data for women and full-term newborns, regardless of the delivery method, meet the inclusion criteria for this study. All maternal files involving home births, premature births, and referrals from other facilities following deliveries were disqualified. The information was gathered and examined by researchers.

Results: The current study involved 93 full term neonates; 58 were males and 35 were females with male: female ratio of 1.65:1. Of them 35 (37.6%) neonates delivered by normal vaginal delivery while the remaining 58 (62.4%) delivered through cesarean section. The mean Apgar score at 1 min was 5.311±2.274 while at 5 min. was 7.462± 1.891 and the mean maternal age was 27.57± as 5.942 years. The commonest risk factors found was obstructed labor with mean Apgar score of 3.381±1.687 at 1 min and 6.142±1.768 at 5 min, followed by previous 2 CS and meconium stained liquor. Neonates with no maternal risks had mean Apgar score of 8.285±0.755 at 1 min and 9.571±0.534 at 5 min. The statistical difference between Apgar score at 1 and 5 min was significant for each of males and females while the difference between males and females was not significant at each of 1 and 5 min. The mean Apgar score at 5 min was significantly higher than that at 1 min for those with maternal risk the difference between those with maternal risk and those with no maternal risk was statistically significant for both at 1 min and 5 min. Furthermore, mean Apgar score at 5 min was significantly higher than that at 1 min for normal vaginal delivery and cesarean section while the difference between Apgar score in normal vaginal delivery and cesarean section at each of 1 and 5 min was not significant. The Apgar scores for at both 1 and 5 min were not significantly correlated with the mothers’ ages.

Conclusions: Mothers who had obstructed labor, had newborns with low Apgar score. At both 1 and 5 minutes, there was a statistically significant difference between the groups with and without maternal risk. The difference in the Apgar score at 1 and 5 minutes for male and female newborns and between those who delivered vaginally normally and via cesarean section was not statistically significant.