Objective: To investigate trends in low 5-minute Apgar scores in (near) term singletons. Design: Nationwide cohort study. Setting: The Netherlands. Population: A cohort of 1,583,188 singletons liveborn between 35 and 42 weeks of gestation in the period 2010-2019 from the Dutch Perinatal Registry. Methods: We studied trends using Cochrane-Armitage trend tests. Risk factors were studied by logistic regression analysis and Population Attributable Risk (PAR) calculation. Main outcome measures: Low 5-minute Apgar score (<7 and <4) as primary outcome. Results: The proportion of infants with low 5-minute Apgar score <7 and <4 increased significantly between 2010 and 2019 (1.04-1.42% (p<0.001), 0.17-0.19% (p=0.009), respectively). While neonatal mortality remained unchanged, NICU admissions and low umbilical artery pH’s increased significantly. Many perinatal characteristics showed a significant association with low Apgar scores. The highest risks were found for nulliparity, epidural analgesia, emergency caesarean section, instrumental vaginal delivery, prolonged second stage of labour, male sex and delivery in secondary care. The obstetric interventions induction of labour, epidural analgesia and planned caesarean section showed an increasing trend. Instrumental vaginal delivery and emergency caesarean section were performed less frequently over time, however within these obstetric intervention subgroups the highest increase in low Apgar scores was observed. Conclusions In the Netherlands, the risk of a low 5-minute Apgar score increased significantly over the last decade, with the highest increase being observed in the obstetric intervention subgroups of instrumental vaginal delivery and emergency caesarean section. Neonatal mortality remained stable over the study period.