Many people believe that APGAR stands for Appearance, Pulse, gesticulation, Activity and Respiration (Appearance, Pulse, Grimace, Activity, Respiration, in English), the parameters five evaluated in newborns to determine their health status immediately after delivery.
This is true, but only in part. It is actually a retro acronym, a type of acronym in which, from a word – in this case, Apgar – an acronym is invented that matches it.
Apgar? What is Apgar ? It is the last name of the person who proposed the famous test of the same name. This procedure is used to assess the health of newborns and has managed to significantly reduce infant mortality worldwide .
Virginia Apgar, anesthesiologist
Virginia Apgar was born on June 7, 1909 in Westfield, New Jersey (United States). She was the youngest of the three children of Helen May (Clarke) and Charles Emory Apgar. His older brother died prematurely from tuberculosis and his second brother suffered from a chronic disease. It is likely that these adversities were the reason why, upon graduating from Westfield High School in 1925, Virginia was clear that she wanted to be a doctor.
He began studying at Mount Holyoke College and graduated in 1929 with a specialty in zoology, with minors in physiology and chemistry. From there he went on to study medicine at Columbia University, graduating in 1933 from the College of Physicians and Surgeons.
Virginia wanted to be a surgeon. She got an internship at Columbia, but Allen Whipple, the head of surgery at Columbia-Presbyterian Medical Center, advised her not to continue her career as a surgeon. She argued that other women she supervised had not been successful in that discipline.
However, he encouraged her to pursue anesthesiology – a specialty practiced at the time primarily by nurses – an essential discipline in surgery that Whipple believed needed improvements and innovations. The surgeon believed that Virginia had the “energy, intelligence and skill to make significant contributions in this area.”
Virginia listened to him and trained for six months with anesthesiologist Ralph Waters at the University of Wisconsin-Madison. She was the only woman in a group of fifteen other students. He completed his training for another six months with anesthesiologist Ernest Rovenstine at Bellevue Hospital in New York.
In 1938 he returned to Columbia, the newly formed division of anesthesiology, as an assistant. Despite her degree, she had trouble hiring doctors to work for her: surgeons did not view anesthesiologists as equals, and the salary was low. Apgar was the only person hired in that division until the mid-1940s.
In 1946, anesthesiology began to become a recognized medical specialty, with residency training required. In 1949, when anesthesiology research led to the formation of an academic department, Virginia Apgar became the center’s first female full professor.
He began to study the effects on newborns of anesthesia given to women during childbirth. His greatest contribution to the field was the famous Apgar test.
The Apgar test
Between the 1930s and 1950s, the infant mortality rate in the United States decreased markedly. However, deaths up to the first 24 hours after birth remained constant. Apgar began to investigate to try to stop this trend.
As an obstetric anesthesiologist, she was able to analyze thousands of deliveries and detect those peculiarities that could help to recognize healthy babies from those who had problems.
After presenting his research at a congress, in 1953 he published the article in which he proposed his test to evaluate the health of newborn babies. Despite initial resistance, his test was finally accepted and is still used around the world.
The Apgar test assigns each newborn a score of 2, 1 or 0 – 2 means that the newborn is in optimal condition and 0 that it is in danger – in each of the following five categories:
- Color: normal / bluish hands and feet / pale or bluish body (Appearance).
- Heart rate: greater than 100 beats per minute / less than 100 beats or no pulse (Pulse).
- Reflexes: reacts to stimulation / small facial gestures / no response (Gesticulation).
- Muscle tone: spontaneous activity / arms and legs bent with little movement / no movement (Activity).
- Respiratory rate and effort: normal and adequate / slow crying and weak / absent crying (Breathing).
The sum of the scores for each newborn therefore ranges from 0 to 10, with 10 being the optimal score. The test is performed one minute after birth and, if necessary, five minutes later.
Apgar related the score to the development of labor and the anesthetics applied to the mother. For example, and with the help of colleagues with knowledge of cardiology, he showed that cyclopropane anesthesia could cause low oxygen levels in babies and therefore low test scores.
Other contributions
In 1959, Apgar left Columbia and earned a Master of Public Health from the Johns Hopkins School of Hygiene and Public Health. From that year until her death, she worked for the March of Dimes Foundation as director of a new division of birth defects and, later, as vice president of medical affairs.
Virginia was one of the first people to warn about the problems related to premature births, since gestational age – the age of an embryo or a newborn from the first day of the last menstruation – is directly related to the test score Apgar.
During the 1964–65 rubella pandemic, Apgar became an advocate for universal vaccination to prevent mother-to-child transmission of rubella. Remember that rubella can cause serious congenital disorders – such as vision loss and blindness, hearing loss, heart disease, cognitive disability or cerebral palsy – if a woman becomes infected during pregnancy.
In front of diverse audiences, Apgar spent much of his time lecturing on the importance of early detection of birth defects and the need for research in this area.
Virginia Apgar was also a professor of pediatrics at Cornell University School of Medicine. There she taught teratology, being the first to hold a teaching position in this new area of pediatrics.
Apgar published more than sixty scientific articles, numerous short writings for newspapers and magazines, and the book Is My Baby All Right? . She was widely recognized for all her contributions. He passed away on August 7, 1974.
Author: Marta Macho-Stadler Professor of Mathematics, University of the Basque Country / University of the Basque Country
This article was originally published on The Conversation under a Creative Commons License. You can read the original article here .
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