Increasing trends in a low 5-min Apgar score among (near) term singletons: a Dutch nationwide cohort study

Objective To investigate trends in low Apgar scores in (near) term singletons using the Dutch Perinatal Registry. Methods In a cohort of 1,583,188 singletons liveborn ≥35 weeks of gestation in the period 2010–2019, we studied trends in low 5-min Apgar scores (<7 and <4) using Cochrane Armitage trend tests. Results The proportion of infants with low Apgar scores <7 and <4 increased significantly between 2010–2019 (1.04–1.42% ( p < 0.001), 0.17–0.19% ( p = 0.009), respectively). Neonatal mortality remained unchanged. Induction of labour, epidural analgesia and planned caesarean section showed an increasing trend. Instrumental vaginal delivery and emergency caesarean section were performed less frequently over time, but these intervention subgroups showed the highest relative increase in infants with low Apgar scores. Conclusions In the Netherlands, the risk of a low 5-min Apgar score increased over the last decade. The highest relative increase was observed in subgroups of instrumental vaginal delivery and emergency caesarean section.