Background: New born babies with low Apgar scores are at an increased risk of perinatal morbidity and mortality.

Objective: To assess proportion and factors associated with low 5^th minute Apgar Apgar score among singleton newborn babies in Gondar University referral hospital; North West Ethiopia.

Methods: A cross-sectional study was conducted on singleton 261 live births from March - May, 2013. Data was collected from mother/newborn index using a structured and pre-tested questionnaire. It was then cleaned, coded and entered using EPI INFO version 3.4.3, then analyzed with IBM SPSS statistics versions 20.0. Logistic regression was used to identify significant variables with low 5^th minute Apgar score.

Result: The proportion of low 5^th minute Apgar score in this study was 13.8%. Factors that were significantly associated with low 5^th minute Apgar score were: non-vertex fetal presentation, prolonged labor, presence of meconium stained liquor, induced/ augmented labor and low birth weight.

Conclusion: Mainly obstetric factors contribute to low Apgar score. Improving labor management through implementing regular use of partograph, 1:1 midwife-client ratio and advanced electronic fetal monitoring technology is recommended.