Introduction Apgar score (AS) of less than 7 at 5 minutes after birth may not essentially be associated with significant brain damage but recent studies suggest that it is associated with subtle cognitive impairment with twice the risk of special education requirements.1 2

Objective To evaluate the risk factors for AS of less than 7 at 5 minutes after birth in term neonates.

Methods Retrospective review of maternity database to identify 86 live born neonates with AS <7 @ 5 minutes after birth, during a period of one year in a large tertiary care maternity unit. Multiple pregnancies and neonates born preterm or with congenital malformations were excluded to identify a sample of 31 neonates for detailed analysis of maternal case notes.

Results 52.6% of mothers were prims with mean age of 26.7yrs. 64.5% of neonates were above 38 weeks of gestation. Although, only 29% pregnancies were high risk at the start of labour, 59% of low risk pregnancies developed intrapartum risk factors (maternal pyrexia, tachycardia, meconium) while 68.2% of low risk pregnancies developed CTG changes. 45.5% of CTG changes were not acted upon. Only18% of low risk pregnancies developed significant intrapartum events (abruption, shoulder dystocia), but 59% of neonates from low risk pregnancies were admitted to the neonatal unit with 46% of them needing intubation.

Conclusion Low AS in term neonates seems to be associated with intrapartum risk factors. Birth attendants should focus more on early recognition of risk factors in labour with continuous risk assessment and taking appropriate action.