In an intention to treat analyses, as compared to room air use of oxygen for intrauterine resuscitation of patients with category II fetal heart tracings does not result in a better fetal outcome or improve fetal metabolic status. The findings were published online July 23, 2018, in JAMA Pediatrics.
Two-thirds of women in labor are given oxygen in an attempt to reverse perceived fetal hypoxemia and prevent acidemia. It is also routinely administered to all laboring mother with intermediate risk for acidemia as evident by the category II fetal heart tracings.
American Academy of Pediatrics recommends against initial neonatal resuscitation with oxygen, as hyperoxygenation results in significant morbidity.
A 2012 review also states, “There is not enough evidence to support the use of prophylactic oxygen therapy for women in labor, nor to evaluate its effectiveness for fetal distress.”
Dr. Raghuraman from the Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, St Louis, Missouri designed this randomized, noninferiority trial to test the hypothesis that room air is as good as oxygen in improving fetal metabolic status as represented by umbilical artery lactate. (ClinicalTrials.gov
Identifier: NCT02741284)
Umbilical artery lactate is a marker of metabolic acidosis and neonatal morbidity.
Women in labor with singleton pregnancies at 37 weeks’ gestational age, admitted to a single tertiary center were eligible to be included in the study (705). Of these, 114 patients developed a category II tracing and were randomized to receive either room air without a face mask or 10 L of oxygen per minute by nonrebreather facemask until delivery.
There was no significant difference in the levels of umbilical artery lactate between the oxygen group (30.6 mg/dL) and the room air group (31.5 mg/dL). The two groups were also similar regarding pH, base deficit, the partial pressure of oxygen, and partial pressure of carbon dioxide.
The rates of operative vaginal delivery or cesarean section for non-reassuring fetal heart rate were also similar in both the groups.
Three other previous studies have also shown similar results, prompting Dr. Christopher P. Bonafide from Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, who co-authored an editorial related to this report to urge the medical societies responsible for issuing evidence-based guidelines for obstetrics such as the American College of Obstetricians and Gynecologists to re-examine the most current research and consider issuing new recommendations against maternal supplemental oxygen administration when fetal tracings are intermediate risk.
Dr. Nandini Raghuraman quotes to Reuters Health by email, "I found it very interesting that substituting room air for oxygen did not impact umbilical cord gases, we typically administer maternal oxygen supplementation in hopes of improving fetal status as interpreted by electronic fetal monitoring. Our results suggest that this may not be the case."
She further added, "Another important point this study raises is that we lack high-quality data for many of our commonly used intrauterine resuscitation techniques. The results call for a closer look and thorough understanding of how these techniques affect fetal and maternal physiology."
Three other previous studies have also shown similar results, prompting Dr. Christopher P. Bonafide from Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, who co-authored an editorial related to this report to urge the medical societies responsible for issuing evidence-based guidelines for obstetrics such as the American College of Obstetricians and Gynecologists to re-examine the most current research and consider issuing new recommendations against maternal supplemental oxygen administration when fetal tracings are intermediate risk.
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