Main findings
In this nationwide Dutch study, we found a significant increase in low 5-minute Apgar scores, <7 and <4, in (near) term liveborn singletons over the period 2010-2019. Neonatal mortality remained unchanged. The obstetric interventions planned caesarean section, induction of labour and epidural analgesia showed a significant increase over the last ten years. Strikingly, instrumental vaginal delivery and emergency caesarean section were performed less frequently over the last 10 years, but within these obstetric intervention subgroups the highest increase in low Apgar scores (<7 and <4) was observed. In primary care, we observed an overall low risk for a low Apgar score.