Maternal oxygen desaturation with intravenous magnesium therapy

Thorp, James A.; Неймарк, М. И.; Poskin, Mary

doi:10.1016/s0029-7844(97)00155-5

Cited by 9 publications

(5 citation statements)

References 2 publications

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“…13,14 In the current study, and supported by our Delphi consensus group, SpO 2 < 90% was a component of the combined adverse maternal outcome. As the PIERS study aims to predict outcomes, only the pulse oximetry readings before an adverse outcome were used and, therefore, there are no values for SpO 2 < 90% in the PIERS database.…”

Section: Predicted Probability Predicted Probabilitysupporting

confidence: 66%

“…In order to prevent overreporting of adverse outcomes resulting from the side effects of magnesium sulphate use, this study used a Glasgow Coma Scale score of < 13 (rather than < 15) as the criterion for adverse outcome to account for the drowsiness associated with magnesium sulphate use. In examining the relationship between preeclampsia, magnesium sulphate, and SpO 2 , Thorp et al 13 did not find a higher risk of oxygen desaturation in women with preeclampsia than in women receiving magnesium sulphate for other reasons; SpO 2 < 90% was used as the definition of oxygen desaturation.The major weakness of this study is that 489 women (25%) in the PIERS database were excluded because they did not have SpO 2 recorded within 48 hours of eligibility and before occurrence of an adverse outcome, yet 60 of these women (12.3%) experienced one or more components of the combined adverse maternal …”

Section: Discussionmentioning

confidence: 99%

“…Although most would agree that an SpO 2 < 90% constitutes an abnormal value (or hypoxemia), some studies of pregnant women have used much higher values (up to SpO 2 < 95%) to classify desaturations. [11][12][13][14] In this study, we aimed to evaluate the predictive value of SpO 2 in pregnant women admitted to hospital with preeclampsia and to establish risk levels that are more clinically informative than the simple and traditional classifications of "normal" or "hypoxic." A secondary aim was to determine whether or not the symptom complex of chest pain and/or dyspnea improves the discriminative power of SpO 2 in assessing women admitted to hospital with preeclampsia.…”

Section: Introductionmentioning

confidence: 99%

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Oxygen Saturation as a Predictor of Adverse Maternal Outcomes in Women with Preeclampsia

Millman

Payne

et al. 2011

Journal of Obstetrics and Gynaecology Canada

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Objective: We sought to determine the role of respiratory assessment by cardiorespiratory symptoms and/or oxygen saturation by pulse oximetry (SpO 2 ) in predicting adverse maternal outcomes in women admitted to hospital with preeclampsia .Methods: These data derive from an international, prospective multicentre cohort study, PIERS (Pre-eclampsia Integrated Estimate of RiSk), which assesses predictors of adverse outcomes in women admitted to tertiary perinatal units with preeclampsia . Univariate and multivariate analyses of cardiorespiratory symptoms and pulse oximetry were performed to assess their ability to predict a combined adverse maternal outcome developed through international Delphi consensus .Results: SpO 2 successfully predicted adverse maternal outcomes; the area under the receiver-operator characteristic curve (AUC ROC) was 0 .71 (95% CI 0 .65 to 0 .77) . Combining the symptoms of chest pain and/or dyspnea with pulse oximetry improved this predictive ability (AUC ROC 0 .73; 95% CI 0 .67 to 0 .78) . When SpO 2 was stratified into risk groups using inflection points on the ROC curve, the highest risk group (SpO 2 90% to 93%) had an odds ratio of 18 .1 (95% CI 8 .2 to 40 .2) for all outcomes within 48 hours when compared with the baseline group (SpO 2 98% to 100%) . Conclusion:Assessing SpO 2 aids in the assessment of maternal risk in women admitted to hospital with preeclampsia . An SpO 2 value of ≤ 93% confers particular risk . The symptom complex of chest pain and/or dyspnea adds to the association . RésuméObjectif : Nous avons cherché à déterminer le rôle de l'évaluation respiratoire en fonction des symptômes cardiorespiratoires et/ou celui de la détermination de la saturation en oxygène par oxymétrie pulsée (SaO 2 ) dans la prédiction des issues maternelles indésirables chez les femmes hospitalisées en raison d'une prééclampsie . Méthodes :Ces données sont issues de l'étude de cohorte multicentrique prospective internationale PIERS (Pre-eclampsia Integrated Estimate of RiSk), laquelle a évalué les facteurs prédictifs des issues indésirables chez les femmes admises dans des unités périnatales tertiaires en raison d'une prééclampsie . Des analyses univariées et multivariées des symptômes cardiorespiratoires et de l'oxymétrie pulsée ont été menées pour en évaluer la capacité de prédire une issue maternelle indésirable combinée, élaborée par consensus Delphi international .Résultats : La SaO 2 a permis de prédire avec succès les issues maternelles indésirables; la surface sous la courbe de la fonction d'efficacité de l'observateur-opérateur (AUC ROC) était de 0,71 (IC à 95 %, 0,65 -0,77) . Le fait de combiner les symptômes de la douleur thoracique et/ou de la dyspnée à l'oxymétrie pulsée a entraîné l'amélioration de cette capacité de prédiction (AUC ROC, 0,73; IC à 95 %, 0,78

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Section: Predicted Probability Predicted Probabilitysupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oxygen Saturation as a Predictor of Adverse Maternal Outcomes in Women with Preeclampsia

Millman

Payne

et al. 2011

Journal of Obstetrics and Gynaecology Canada

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“…Respiratory failure may result if these conditions are ignored. Although some previous studies reported that desaturation episodes did not cause decompensation in maternal and fetal status, a continuous pulse oximeter was available for added vigilance in those studies, and treatment was started as soon as desaturation was detected [16, 17]. …”

Section: Discussionmentioning

confidence: 99%

Effects of Supplemental Oxygen on Maternal and Neonatal Oxygenation in Elective Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial

Siriussawakul

Triyasunant

Nimmannit

et al. 2014

BioMed Research International

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The use of supplemental oxygen in uncomplicated cesarean deliveries under spinal anesthesia has been thoroughly investigated during recent decades. The aim of this study was to determine the benefits for both mother and infant of administering supplemental, low-dose oxygen via a nasal cannula versus having no supplement (i.e., room air only). Healthy parturients at term undergoing elective cesarean section under spinal anesthesia were randomly allocated into two groups: an oxygen group (n = 170), who received 3 LPM oxygen via a nasal cannula; and a room-air group (n = 170), who were assigned to breathe room air. Maternal oxygen saturation was measured continuously by using pulse oximeter. The desaturation was determined by oxygen saturation <94% over 30 seconds. Umbilical cord gases and Apgar scores were collected followed delivery of the infant. All maternal desaturation events occurred in 12 parturients assigned to the room-air group. Most events were concurrent with hypotension. The umbilical venous partial pressure of oxygen was significantly higher in the oxygen group. The other blood gas measurements and Apgar scores were not significantly different between the two groups. Based on our findings, the use of supplemental oxygen could prevent maternal desaturation resulting from receiving sedation and intraoperative hypotension.

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“…Hypoxaemia has been defined as SaO2 of < 94%; < 92%; < 90%; or PaO 2 < 60 mm Hg or < 8 kPa by various authors (7,8,10,12). We defined oxygen desaturation as SpO 2 < 94% as proposed by O'Driscoll et al (7).…”

Section: Discussionmentioning

confidence: 99%

Incidence of Maternal Desaturation among Patients Undergoing Elective Caesaraen Section under Regional Anaesthesia

Yee¹

2017

JSA

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This was a prospective observational study to identify the incidence and possible risk factors for maternal desaturation following neuraxial blockade for elective caesarean section (CS). Patients with body mass index (BMI) ≥ 30 kg/m 2 at the first antenatal consultation were identified and classified into the obese group. Neuraxial blockade in the form of subarachnoid block (SAB) or combined spinal-epidural (CSE) was performed. Mean arterial pressure (MAP) and oxygen saturation (SpO 2 ) were recorded at baseline and at 5-minute intervals following neuraxial blockade. Desaturation, defined as SpO 2 < 94% for more than 30 seconds without artifacts, was managed with oxygen therapy and other appropriate measures. Newborn Apgar score and umbilical cord blood gases were analysed. Among a total of 254 recruited patients, 69 (27.2%) were obese and were associated with significantly higher age, parity, previous CS and pre-existing diabetes mellitus. The incidence of oxygen desaturation was 1.2%, involving three patients in the non obese group. These desaturation episodes were short-lived and associated with intraoperative hypotension. Six patients, two of whom in the obese group, received rescue oxygen therapy following intraoperative events such as deteriorating SpO 2 or hypotension. The mean MAP was significantly lower at baseline and at 5 minutes post neuraxial blockade in the non obese group, which could account for the occurrence of desaturation in this group only. There were no significant inter-group differences in terms of neonatal outcome, umbilical cord blood gases and changes in mean SpO 2 post neuraxial blockade. In conclusion, the current practice of not routinely giving supplementary oxygen to patient during elective CS at our institution is deemed to be safe, provided continuous SpO 2 monitoring is available throughout the surgery. Further randomised clinical trials are indicated to investigate the impact of maternal obesity and of labouring patients presenting for urgent or emergency CS on intraoperative oxygen desaturation.

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Maternal oxygen desaturation with intravenous magnesium therapy

Cited by 9 publications

References 2 publications

Oxygen Saturation as a Predictor of Adverse Maternal Outcomes in Women with Preeclampsia

Oxygen Saturation as a Predictor of Adverse Maternal Outcomes in Women with Preeclampsia

Effects of Supplemental Oxygen on Maternal and Neonatal Oxygenation in Elective Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial

Incidence of Maternal Desaturation among Patients Undergoing Elective Caesaraen Section under Regional Anaesthesia

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