An Apgar score of three or less at one minute is not diagnostic of birth asphyxia but is a useful screening test for neonatal encephalopathy.

OBJECTIVE: To evaluate the relationship between an Apgar score of three or less at one minute of life and the subsequent risk of developing neonatal encephalopathy (NE). DESIGN: Prospective. SETTING: The principal maternity hospital of Kathmandu, Nepal, a low income country, where over 50% of the local population deliver. METHODS: All liveborn infants over a 12 month period with a birthweight of 500 g or more were assessed by the Apgar scoring system at one minute of age. All term infants with neurological abnormalities presenting in the first day of life were systematically examined and described according to a conventionally defined encephalopathy grading system. Major congenital malformations and neonatal infections were excluded. RESULTS: Over 12 months there were 14,771 total births of a weight of 500 g or more of which 14,371 were live births and 400 were stillbirths. Of 734 infants with 1 min Apgar of three or less, 91 developed NE. The positive and negative predictive values of 1 min Apgar of three or less for NE were 11.4% and 99.9%, respectively. The probability of developing NE rose from 0.6% (amongst all infants born at this hospital) to 11.2% (amongst infants born with a one minute Apgar of three or less). CONCLUSIONS: An Apgar score of 3 or less at one minute is a useful screening test for clinically significant birth asphyxia (NE). It overestimates by eight fold the scale of the birth asphyxia problem, but identifies a high risk group requiring further observation of their neurological condition.

Traumatismo obstétrico: incidencia, clasificación y factores asociados / Obstetical trauma: Incidence, classification and associated factors

Evaluación prospectiva de una cohorte de recién nacidos, para determinar la incidencia de Traumatismo Obstétrico (TO), la clasificación en sus diferentes tipos, y los factores asociados a la ocurrencia de TO, definido éste como toda lesión producto de fuerzas que intervengan en el periodo comprendido entre el inicio del trabajo de parto y el pinzamiento del cordón umbilical. De agosto 1987 a julio de 1990 (tres años) se diagnosticó TO en 39 de 1155 recién nacidos vivos, lo que da una incidencia de 3.4 por ciento o 33.8 por 1000 nacidos vivos. El TO más frecuente fue cefalohematoma (25/39), seguido de fractura de clavícula (8/39), equimiosis de tejidos blandos (4/39), hematoma de tejidos blandos (2/39), heridas (2/39), lesión de plexo braquial (1/39) y hematoma subgaleal (1/39). Se encontró asociación significativa de la ocurrencia de TO con peso para la edad gestacional: nacimiento vía vaginal;aplicación de fórceps, sobre todo medios, y con el uso de inductoconducción.