The effect of intrauterine resuscitation by maternal hyperoxygenation on perinatal and maternal outcome: a randomized controlled trial

Abstract

BACKGROUND: Maternal hyperoxygenation is widely used during labor as an intrauterine resuscitation technique. However, robust evidence regarding its beneficial effect and potential side effects is scarce, and previous studies show conflicting results. OBJECTIVE: To assess the effect of maternal hyperoxygenation upon suspected fetal distress during the second stage of term labor on fetal heart rate, neonatal outcome, maternal side effects, and mode of delivery. MATERIALS AND METHODS: In a single-center randomized controlled trial in a tertiary hospital in The Netherlands, participants were randomized in case of an intermediary or abnormal fetal heart rate pattern during the second stage of term labor, to receive either conventional care or 100% oxygen at 10 L/min until delivery. The primary outcome was the change in fetal heart rate pattern. Prespecified secondary outcomes were Apgar score, umbilical cord blood gas analysis, neonatal intensive care unit admission, perinatal death, free oxygen radical activity, maternal side effects, and mode of delivery. We performed subgroup analyses for intermediary and abnormal fetal heart rate, and for small for gestational age fetuses. RESULTS: From March 2016 through April 2018, a total of 117 women were included. Fetal heart rate patterns could be analyzed in 71 women. Changes in fetal heart rate (defined as improvement, equal, or deterioration) in favor of maternal hyperoxygenation were significant (odds ratio, 5.7; 95% confidence interval, 1.7À19.1) using ordinal logistic regression. Apgar score, umbilical cord blood gas analysis, free oxygen radicals, and mode of delivery showed no significant differences between the intervention and control group. Among women with an abnormal fetal heart rate, there were fewer episiotomies on fetal indication in the intervention group (25%) than in the control group (65%, P < .01). CONCLUSION: Maternal hyperoxygenation has a positive effect on the fetal heart rate in the presence of suspected fetal distress during the second stage of labor. There was no significant difference in the mode of delivery or neonatal outcome; however, significantly fewer episiotomies on fetal indication were performed following maternal hyperoxygenation in the subgroup with abnormal fetal heart rate pattern.

Effect of intrapartum oxygen on the rate of cesarean delivery: a meta-analysis

“…Five total articles were included in the systematic review and meta-analysis. [15][16][17][18][19] The search process according to the PRISMA statement is shown in Figure 1.…”

“…Characteristics of the five included studies in the meta-analysis are included in Table 1. [15][16][17][18][19] Two studies administered oxygen for NRFHM, 17,18 two administered oxygen prophylactically during the 2 nd stage, 15,19 and one administered oxygen prophylactically for at least 30 minutes before delivery. 16 Two studies administered oxygen at 2L/min 15,16 while three administered oxygen at10L/min.…”

“…16 Two studies administered oxygen at 2L/min 15,16 while three administered oxygen at10L/min. [17][18][19] Risk of bias is outlined in Figure 2. In general, bias was considered low in most areas.…”

“…Two studies included a sham nasal cannula for the control group 15,16 while the other three studies did not. [17][18][19] Three studies were considered high risk of attrition bias due to >10% missing data, particularly of cord gases. 15,17,18 No other sources of bias were identified.…”

“…All authors were contacted to obtain supplemental data and authors from three studies provided missing data. [16][17][18] Notably, the data by Nesterenko et al did not include indication for CD and included both planned and unplanned CD. Therefore, data were only abstracted from the full data set for patients who had successful vaginal deliveries and data were reported only on neonatal and cord blood outcomes, not for the primary outcome.…”