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Virginia Apgar Kimdir?
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[Resim: Virginia-Apgar-Kimdir.png]

Virginia Apgar Kimdir?

1952 yılında bir hastane kafeteryasında kahvaltı yaptığında bir bebeğin doğumunun ne kadar iyi geçtiğini değerlendirmek için bir yol buldu. Derhal beş değerlendirme kriteri yazdı: Solunum, kalp hızı, kas tonu, refleksler ve cilt rengi. Tarihe “Apgar Skorlaması” olarak geçen ve yeni doğan bebeklerin sağlık durumunu kontrol etmeyi amaçlayan bu testin mucidi Dr. Virginia Apgar’ın kim olduğunu bilmiyor olabilirsiniz, ama bir ihtimal bu kişi, bir bebeğin annenin rahmindan dünyaya geldiğinde o bebeğin hayatına dokunmuş olabilir.

Virginia Apgar kimdir?

1909 doğumlu Virginia Apgar, kadınlar hâlâ tıp alanına girmek için mücadele ettiği bir dönemde büyüdü. Apgar’ın bir kardeşi tüberkülozdan öldü ve diğer kardeşi çocukluk dönemi hastalıklarıyla uğraşıyordu. Bu miras, huzursuz bir merak duygusu ile birlikte Apgar’ı tıp okumaya itti ve tıbbi derecesini elde etmek için bir ilham kaynağı oldu.

Apgar’ın başarısı etkileyicidir. O, Columbia Üniversitesi Presbyterian Hastanesi’nde Hekimler ve Cerrahlar Koleji’nde profesör olarak çalışan, bir bölüm yöneten ve yenidoğan bakımı için kritik bir araç tasarlayan ilk kadın doktordur. Ayrıca hastalar için büyük bir savunucuydu. Karşılanmamış bir klinik ihtiyaca göre nispeten basit bir çözüm bulan ve bebek ölüm hızlarını azaltmada önemli katkı sağlamıştır.

En önemlisi, “Apgar Skorlaması” olarak adlandırılan ve yeni doğmuş bebekleri algılamanın değiştirilmesi üzerinde kalıcı bir etkiye sahiptir. Bir anestezi doktoru olan Apgar’dan önce anestezinin annelere olan etkleri üzerinde durulmuş, bebekler ikinci planda tutulmuştur. İşte daha önce doğumun bir yan ürünü olarak görülen yenidoğanlar Apgar’dan sonra artık doğum salonunda bakım merkezindedir. 60 yılı aşkın bir süredir, teknolojideki önemli gelişmelere rağmen,” Apgar Skorlaması” yeni doğmuş bir bebeğin ilk tıbbi değerlendirmesidir.
Abgar Skorlaması nedir?

“Apgar skorlaması” olarak anılan bu testte, 5 objektif bulguya dayanılarak verilen puanlardan toplanan skorun 10 olması halinde Apgar skoruna göre yeni doğmuş bebeğin durumunun mükemmel olduğu kabul edilir.

Bu 5 bulgu; bebeğin solunumu, kalp hızı, kas tonu, refleks cevabı ve cilt rengidir.

Anne ve bebeğe bağlı sebeplerin her biri APGAR skorlamasının düşük olmasına sebep olur. Doğum öncesi ve doğum sırasında bebeği sıkıntıya sokabilecek anne ve bebeğe ait birçok etken APGAR test sonucunu etkileyen nedenler olarak sayılabilir.

Özellikle 10.dakika APGAR’ın düşük olması ilerideki nörolojik hasarı gösterebilmesi açısından önemlidir. Genel olarak APGAR skoru 8’in üzerinde olan bebekler sağlıklı kabul edilirler ancak bebeğin sağlıklı olduğunun tek göstergesi bu değildir.

“Apgar Skoru”nun geliştirilmesi, çoğunlukla Dr. Apgar’ın dahil olduğu doğum kusurlarının önlenmesi ve tedavisi ile ilgili zengin bir araştırmaya ilham kaynağı oldu.

1959’da, Ulusal Ifantil Felç Vakfı (bugünkü Dimes March olarak da bilinir) doğumsal kusurların bölünmesinin direktörlüğünü yapmıştır; bu pozisyon 1974’te ölümüne kadar devam etmiştir.

“Doğruluk kusurlarına ulusal dikkat gösterilmesi, bu koşulların bebek ölümlerinde önemli katkı sağladığına” işaret etti. “Dr. Apgar’ın Dimes March’daki çalışması doğum kusurlarını önlemek ve böylece bebek ölümlerini azaltmak için ülke çapında faaliyetlere yol açtı.”

Karmaşık tıbbi problemleri halka iletmek için pratik bir çözüm bularak Dr. Apgar, algılamadaki değişikliğin sağlık üzerinde nasıl derin bir etkisi olabileceğini bir kez daha ortaya koymuştur.

Virginia Apgar

Virginia Apgar (June 7, 1909 – August 7, 1974) was an Armenian-American obstetrical anesthesiologist, best known as the inventor of the Apgar score, a way to quickly assess the health of a newborn child immediately after birth. She was a leader in the fields of anesthesiology and teratology, and introduced obstetrical considerations to the established field of neonatology.

Early life and education

The youngest of three children, Apgar was born and raised in Westfield, New Jersey. Her father was an insurance executive, and also an amateur inventor and astronomer.[1] Her older brother died early from tuberculosis, and her other brother had a chronic illness.[2] She graduated from Westfield High School in 1925, knowing that she wanted to be a doctor.[3]

Apgar graduated from Mount Holyoke College in 1929, where she studied zoology with minors in physiology and chemistry.[4] In 1933, she graduated fourth in her class from Columbia University College of Physicians and Surgeons (P&S)[2] and completed a residency in surgery at P&S in 1937.

She was discouraged by Dr. Allen Whipple, the chairman of surgery at Columbia-Presbyterian Medical Center, from continuing her career as a surgeon because he had seen many women attempt to be successful surgeons and ultimately fail. He instead encouraged her to practice anesthesiology because he felt that advancements in anesthesia were needed to further advance surgery and felt that she had the "energy and ability" to make a significant contribution.[2] Deciding to continue her career in anesthesiology, she trained for six months under Dr. Ralph Waters at the University of Wisconsin–Madison, where he had established the first anesthesiology department in the United States.[2] She then studied for a further six months under Dr. Ernest Rovenstine in New York at Bellevue Hospital.[2] She received a certification as an anesthesiologist in 1937,[4] and returned to P&S in 1938 as director of the newly formed division of anesthesia.[5] She later received a masters degree in public health at Johns Hopkins School of Hygiene and Public Health, graduating in 1959

Work and research

As the first woman to head a specialty division at Columbia-Presbyterian Medical Center (now NewYork–Presbyterian Hospital) and Columbia University College of Physicians and Surgeons, Apgar faced many obstacles.[examples needed] In conjunction with Dr. Allen Whipple, she started P&S's anesthesia division. Apgar was placed in charge of the division's administrative duties and was also tasked with coordinating the staffing of the division and its work throughout the hospital. Throughout much of the 1940s, she was an administrator, teacher, recruiter, coordinator and practising physician.[1]

It was often difficult to find residents for the program, as anesthesiology had only recently been converted from a nursing specialty to a physician specialty. New anesthesiologists also faced scrutiny from other physicians, specifically surgeons, who were not used to having an anesthesia-specialized MD in the operating room. These difficulties led to issues in gaining funding and support for the division. With America's entrance into World War II in 1941, many medical professionals enlisted in the military to help the war effort, which created a serious staffing problem for domestic hospitals, Apgar's division included.

When the war ended in 1945, interest in anesthesiology was renewed in returning physicians, and the staffing problem for Apgar's division was quickly resolved. The specialty's growing popularity and Apgar's development of its residency program prompted P&S to establish it as an official department in 1949. Due to her lack of research, Apgar was not made head of the department as was expected and the job was given to her colleague, Dr. Emmanuel Papper. Apgar was given a faculty position at P&S.[1]
Obstetrics

In 1949, Apgar became the first woman to become a full professor at P&S,[6] where she remained until 1959.[4] During this time, she also did clinical and research work at the affiliated Sloane Hospital for Women, still a division of NewYork–Presbyterian Hospital.[7] 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. [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.[1] Entering into 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 .[8]

In 1959, Apgar left Columbia and earned a Master of Public Health degree from the Johns Hopkins School of Hygiene and Public Health.[4] 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 birth defects.[9]

As 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 premature birth, now one of the March of Dimes top priorities.[9] During this time, she wrote and lectured extensively, authoring articles in popular magazines as well as research work.[4] In 1967, Apgar became vice president and director of basic research at The National Foundation-March of Dimes.[4]

During the rubella pandemic of 1964–65, Apgar became an advocate for universal vaccination to prevent mother-to-child transmission of rubella.[9] 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 miscarriages or therapeutic abortions and 20,000 cases of congenital rubella syndrome. These led to 2,100 deaths in infancy, 12,000 cases of deafness, 3,580 cases of blindness due to cataracts and/or microphthalmia, and 1,800 cases of intellectual disability. In New York City alone, congenital rubella affected 1% of all babies born at that time.[10]

Apgar also promoted effective use of Rh testing, which can identify women who are at risk for transmission of maternal antibodies across the placenta where they may subsequently bind with and destroy fetal red blood cells, resulting in fetal hydrops or even miscarriage.[9]

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.

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 lecturer in medical genetics at the Johns Hopkins School of Public Health.[11]

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.[9]
Personal life

Throughout her career, Apgar maintained that "women are liberated from the time they leave the womb"[citation needed] and that being female had not imposed significant limitations on her medical career. She avoided women's organizations and causes, for the most part. Though she sometimes privately expressed her frustration with gender inequalities (especially in the matter of salaries), she worked around these by consistently pushing into new fields where there was room to exercise her considerable energy and abilities.[11]

Apgar never married, and died of cirrhosis of the liver[12] on August 7, 1974, at Columbia-Presbyterian Medical Center. She is buried at Fairview Cemetery in Westfield.

Music was an integral part of family life, with frequent family music sessions.[13] Apgar played the violin and her brother played piano and organ.[13] She traveled with her violin, often playing in amateur chamber quartets wherever she happened to be. During the 1950s a friend introduced her to instrument-making, and together they made two violins, a viola, and a cello. She was an enthusiastic gardener, and enjoyed fly-fishing, golfing, and stamp collecting. In her fifties, Apgar started taking flying lessons, stating that her goal was to someday fly under New York's George Washington Bridge.[11]
Legacy

Apgar has continued to earn posthumous recognition for her contributions and achievements. In 1994, she was honored by the United States Postal Service with a 20¢ Great Americans series postage stamp. In November 1995 she was inducted into the National Women's Hall of Fame in Seneca Falls, New York. In 1999, she was designated a Women's History Month Honoree by the National Women's History Project.[14] In 2018, Google celebrated Apgar's 109th birthday with a Google Doodle.[15][16]

Honors and awards

Honorary doctorate, Women's Medical College of Pennsylvania (1964)
Honorary doctorate, Mount Holyoke College (1965)
Distinguished Service Award from the American Society of Anesthesiologists (1966)
Elizabeth Blackwell Award, from the American Women's Medical Association (1966)
Honorary doctorate, New Jersey College of Medicine and Dentistry (1967)
Alumni Gold Medal for Distinguished Achievement, Columbia University College of Physicians and Surgeons (1973)
Ralph M. Waters Award, American Society of Anesthesiologists (1973)
Woman of the Year in Science, Ladies Home Journal (1973)
Fellow of the New York Academy of Medicine, the American Public Health Association, and the New York Academy of Sciences.[4]
References

"The Virginia Apgar Papers". U.S. National Library of Medicine: National Institutes of Health. September 21, 2017. Retrieved April 24, 2018.
"Changing the Face of Medicine: Virginia Apgar". U.S. National Library of Medicine. June 3, 2015. Retrieved April 24, 2018.
"The Virginia Apgar Papers: biographical information". Profiles in Science. National Library of Medicine. Retrieved May 17, 2014.
Amschler, Denise (1999). "Apgar, Virginia (1909-1974)". In Commire, Anne. Women in World History: A biographical encyclopedia. Gale. pp. 415–418.
"Dr. Virginia Apgar". Changing the Face of Medicine. National Library of Medicine. Retrieved May 23, 2014.
Women in Medicine Exhibit Resources Archived 2006-09-01 at the Wayback Machine.
Department of Obstetrics and Gynecology Archived 2008-05-17 at the Wayback Machine.
"Association of Apgar scores with death and neurologic disability".
Dezen, Todd P.; Lynch, Elizabeth (2009-06-24). "March of Dimes Honors 100th Anniversary Of Virginia Apgar". White Plains, New York: March of Dimes Foundation.
Pan American Health Organization (1998). "Public Health Burden of Rubella and CRS" (PDF). EPI Newsletter. XX (4). Retrieved 2011-05-15.
"The Virginia Apgar Papers: Biographical Information". profiles.nlm.nih.gov. Retrieved 2018-04-04.
Scrivener, Laurie; Barnes, J. Suzanne (2002). A Biographical Dictionary of Women Healers. Westport, CT: Oryx Press. pp. 6–7. ISBN 1-57356-219-X.
Cite error: The named reference :0 was invoked but never defined (see the help page).
"Honorees: 2010 National Women's History Month". Women's History Month. National Women's History Project. 2010. Retrieved 14 November 2011.
June 7, 2018. "Dr. Virginia Apgar's 109th Birthday". Google.com. Retrieved 2018-06-07.
"Dr. Virginia Apgar Google Doodle". YouTube. Retrieved 2018-06-07.

[Resim: Virginia-Apgar-July-6-1959.jpg]

[Resim: Virginia_Apgar.jpg]

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