Introduction: Low Apgar scores are associated with poor neonatal outcomes, yet significantregional variations exist in their incidence.This study aims to determine the incidence of low Apgar scores below 7 at 5 minutes in a regional hospital in Australia, and to explore associated maternal and obstetric risk factors.Study Design: The study employed an unmatched case-control study design using medical records of infants delivered at or beyond 37 weeks of gestation between 2018 to 2022. Ninety-one neonates with low Apgar scores meeting the inclusion criteria were identified, and an equal number of neonates were included as controls. Key maternal and newborn parameters were evaluated, and specific risk factors. Binary and multivariate analyses at 95% confidence identified factors linked to low five-minute Apgar scores, with significance at p<0.05.Results: 4,344 infants were born during the study period, with a 2.09% incidence of Apgar scores below 7 at 5 minutes. Multivariate analysis revealed that administering morphine prior to delivery significantly decreased the risk of low APGAR scores (AOR 0.13, 95% CI: 0.05–0.38, p < 0.001). Additionally, a history of previous caesarean delivery was associated with a reduced risk of low APGAR scores (AOR 0.31, 95% CI: 0.11–0.87, p = 0.026). Conversely, factors that increased the likelihood of low APGAR scores included prolonged rupture of membranes (AOR 2.91, 95% CI: 1.06–7.95, p = 0.038), caesarean delivery (AOR 2.60, 95% CI: 1.21–5.58, p = 0.014), and shoulder dystocia (AOR 9.38, 95% CI: 1.07–82.54, p = 0.044).Conclusion: Higher rates of low Apgar scores in regional Australia highlight the importance of targeted interventions to enhance neonatal outcomes. Significant maternal risk factors include prolonged membrane rupture, caesarean delivery, and shoulder dystocia, which elevate neonatal risks. Conversely, morphine use and prior caesarean may offer protective effects. Addressing these factors could enhance maternal and neonatal outcomes.
