Editing Virginia Apgar (section)

=== Obstetrics ===

In 1949, Apgar became the first woman to become a [[full professor]] at P&S,<ref>[http://www.mtholyoke.edu/lits/library/changingthefaceofmedicine/connection.shtml MHC Connections : Women in Medicine at Mount Holyoke] {{webarchive|url=https://web.archive.org/web/20060901204109/http://www.mtholyoke.edu/lits/library/changingthefaceofmedicine/connection.shtml |date=September 1, 2006 }}</ref> where she remained until 1959.<ref name="amschler" /> During this time, she also did clinical and research work at the affiliated [[Sloane Hospital for Women]], still a division of [[NewYork–Presbyterian Hospital]].<ref>[http://cumc.columbia.edu/dept/obgyn/about/history.html Department of Obstetrics and Gynecology<!-- Bot generated title -->] {{webarchive|url=https://web.archive.org/web/20080517071324/http://www.cumc.columbia.edu/dept/obgyn/about/history.html |date=May 17, 2008 }}</ref> In 1953, she introduced the first test, called the [[Apgar score]], to assess the health of newborn babies.

Between the 1930s and the 1950s, the United States [[infant mortality rate]] decreased, but the number of infant deaths within the first 24 hours after birth remained constant. Apgar noticed this trend and began to investigate methods for decreasing the infant mortality rate specifically within the first 24 hours of the infant's life. As an obstetric anesthesiologist, Apgar was able to document trends that could distinguish healthy infants from infants in trouble.<ref name=":1" />

This investigation led to a standardized scoring system used to assess a newborn's health after birth, with the result referred to as the newborn's "[[Apgar score]]". Each newborn is given a score of 0, 1 or 2 (a score of 2 meaning the newborn is in optimal condition, 0 being in distress) in each of the following categories: heart rate, respiration, color, muscle tone and reflex irritability. Compiled scores for each newborn can range between 0 and 10, with 10 being the best possible condition for a newborn. The scores were to be given to a newborn one minute after birth, and additional scores could be given in five-minute increments to guide treatment if the newborn's condition did not sufficiently improve. By the 1960s, many hospitals in the United States were using the Apgar score consistently.<ref name=":1" /> In the 21st century, the score continues to be used to provide an accepted and convenient method for reporting the status of the newborn infant immediately after birth .<ref name=":16">{{cite journal|pmc=2943160|title=Association of Apgar scores with death and neurologic disability|journal=Clinical Epidemiology|volume=1|pages=45–53|year=2009|last1=Ehrenstein|first1=V.|pmid=20865086|doi=10.2147/CLEP.S4782 |doi-access=free }}</ref>

In 1959, Apgar left Columbia and earned a [[Professional degrees of public health|Master of Public Health]] degree from the [[Johns Hopkins Bloomberg School of Public Health|Johns Hopkins School of Hygiene and Public Health]].<ref name="amschler" /> From 1959 until her death in 1974, Apgar worked for the [[March of Dimes]] Foundation, serving as vice president for medical affairs and directing its research program to prevent and treat [[Congenital disorder|birth defects]].<ref name="Dezen2011" />

As [[Gestational age (obstetrics)|gestational age]] is directly related to an infant's Apgar score, Apgar was one of the first at the March of Dimes to bring attention to the problem of [[Preterm birth|premature birth]], now one of the March of Dimes' top priorities.<ref name="Dezen2011" /> During this time, she wrote and lectured extensively, writing articles in popular magazines as well as research work.<ref name="amschler" /> In 1967, Apgar became vice president and director of basic research at The National Foundation-March of Dimes.<ref name="amschler" />

During the [[rubella]] [[pandemic]] of 1964–65, Apgar became an advocate for universal [[vaccination]] to prevent [[vertical transmission|mother-to-child transmission]] of rubella.<ref name="Dezen2011">{{cite press release|url=http://www.marchofdimes.org/news/march-of-dimes-honors-100th-anniversary-of-virginia-apgar.aspx|title=March of Dimes Honors 100th Anniversary Of Virginia Apgar|date=June 24, 2009 |publisher=March of Dimes Foundation|location=White Plains, New York}}</ref> Rubella can cause serious congenital disorders if a woman becomes infected while pregnant. Between 1964 and 1965, the United States had an estimated 12.5 million rubella cases, which led to 11,000 [[miscarriage]]s or [[therapeutic abortion]]s and 20,000 cases of [[congenital rubella syndrome]]. These led to 2,100 deaths in infancy, 12,000 cases of [[Sensorineural hearing loss|deafness]], 3,580 cases of blindness due to [[cataract]]s and/or [[microphthalmia]] and 1,800 cases of [[Mental retardation|intellectual disability]]. In New York City alone, congenital rubella affected 1% of all babies born at that time.<ref name="EPI1998">{{cite journal|author=Pan American Health Organization|author-link=Pan American Health Organization|title=Public Health Burden of Rubella and CRS|journal=EPI Newsletter|volume=XX|issue=4|year=1998|url=http://www.ops-oms.org/english/ad/fch/im/nlrubella_PublicHealthBurdenRubellaCRS_Aug1998.pdf|access-date=May 15, 2011|archive-date=July 19, 2011|archive-url=https://web.archive.org/web/20110719123000/http://www.ops-oms.org/english/ad/fch/im/nlrubella_PublicHealthBurdenRubellaCRS_Aug1998.pdf|url-status=dead}}</ref>

Apgar also promoted effective use of [[Rh blood group system|Rh testing]], which can identify women who are at risk for transmission of maternal [[Antibody|antibodies]] across the [[placenta]] where they may subsequently bind with and destroy [[fetus|fetal]] [[red blood cell]]s, resulting in [[Hydrops fetalis|fetal hydrops]] or even [[miscarriage]].<ref name="Dezen2011" />

Apgar traveled thousands of miles each year to speak to widely varied audiences about the importance of early detection of birth defects and the need for more research in this area. She proved an excellent ambassador for the National Foundation, and the annual income of that organization more than doubled during her tenure there. She also served the National Foundation as Director of Basic Medical Research (1967–1968) and vice-president for Medical Affairs (1971–1974). Her concerns for the welfare of children and families were combined with her talent for teaching in the 1972 book ''Is My Baby All Right?'', written with Joan Beck.{{Citation needed|date=December 2023}}

[[File:Virginia Apgar on the President's Committee on Employment of the Handicapped.jpg|thumb|right|300px|Virginia Apgar on the President's Committee on Employment of the Handicapped (November 28, 1973)]]
Apgar was also a lecturer (1965–1971) and then clinical professor (1971–1974) of pediatrics at Cornell University School of Medicine, where she taught teratology (the study of birth defects). She was the first to hold a faculty position in this new area of pediatrics. In 1973, she was appointed a lecturer in medical genetics at the Johns Hopkins School of Public Health.<ref name=":1" />

Apgar published over sixty scientific articles and numerous shorter essays for newspapers and magazines during her career, along with her book, ''Is My Baby All Right?''. She received many awards, including honorary doctorates from the Woman's Medical College of Pennsylvania (1964) and Mount Holyoke College (1965), the Elizabeth Blackwell Award from the American Medical Women's Association (1966), the Distinguished Service Award from the American Society of Anesthesiologists (1966), the Alumni Gold Medal for Distinguished Achievement from Columbia University College of Physicians and Surgeons (1973) and the Ralph M. Waters Award from the American Society of Anesthesiologists (1973). In 1973 she was also elected Woman of the Year in Science by the ''[[Ladies Home Journal]]''.

Apgar was equally at home speaking to teens as she was to the movers and shakers of society. She spoke at March of Dimes Youth Conferences about teen pregnancy and congenital disorders at a time when these topics were considered taboo.<ref name="Dezen2011" />