Liberal versus Indicated Maternal Oxygen Supplementation in Labor: A Before-and-After Trial

Nana-Ama E. Ankumah; Sean C. Blackwell; Mesk A. Alrais; Farah H. Amro; Rachel L. Wiley; Patricia Heale; Maria Hutchinson; Baha M. Sibai

doi:10.1055/s-0038-1639357

American Journal of Perinatology, Table of Contents

Am J Perinatol 2018; 35(11): 1057-1064
DOI: 10.1055/s-0038-1639357

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Liberal versus Indicated Maternal Oxygen Supplementation in Labor: A Before-and-After Trial

Authors

Nana-Ama E. Ankumah

¹Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
Sean C. Blackwell

¹Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
Mesk A. Alrais

¹Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
Farah H. Amro

²Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
Rachel L. Wiley

²Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
Patricia Heale

³Children's Memorial Hermann Hospital, The Women's Center, Labor and Delivery, Houston, Texas
Maria Hutchinson

¹Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
Baha M. Sibai

¹Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas

Abstract

Background Although supplemental oxygen (SO₂) is routinely administered to laboring gravidas, benefits and harms are not well studied.

Objective This article compares strategies of liberal versus indicated SO₂ therapy during labor on cesarean delivery (CD) rate and neonatal outcomes.

Study Design A controlled, before-and-after trial of laboring women with term, singleton pregnancies. During an initial 8-week period, maternal SO₂ was administered at the discretion of the provider followed by an 8-week period where SO₂ was to be given only for protocol indications.

Results Our study included 844 women. There was no difference in number of women receiving SO₂ (53% liberal vs. 50% indicated; p = 0.33). For those receiving SO₂, there was no difference in SO₂ duration (median, 89 minutes [interquartile range, 42–172] vs. 87 minutes [36–152]; p = 0.42). There were no differences in overall CD rate (20% vs. 17%; p = 0.70), CD for nonreassuring fetal status, or use of intrauterine resuscitative measures. There were more 5-minute APGAR < 7 in the indicated group, but no difference in umbilical artery pH < 7.1 or neonatal intensive care unit (NICU) admission.

Conclusion Approximately half of women receive SO₂ intrapartum regardless of a strategy of liberal or indicated oxygen use. There were no clinically significant differences in outcomes between strategies.

Keywords

intrauterine resuscitation - labor - maternal oxygen supplementation - oxygen

Full Text

References

References
1 Fawole B, Hofmeyr GJ. Maternal oxygen administration for fetal distress. Cochrane Database Syst Rev 2012; 12 (12) CD000136
2 Yli BM, Kjellmer I. Pathophysiology of foetal oxygenation and cell damage during labour. Best Pract Res Clin Obstet Gynaecol 2016; 30: 9-21
3 Van der Houst-van der Jagt M, Oei SG, Bovendeerd PHM. Simulation of reflex late decelerations in labor with a mathematical model. Early Hum Dev 2013; 89 (06) 361-369
4 Gare DJ, Shime J, Paul WM, Hoskins M. Oxygen administration during labor. Am J Obstet Gynecol 1969; 105 (06) 954-961
5 Althabe Jr O, Schwarcz RL, Pose SV, Escarcena L, Caldeyro-Barcia R. Effects on fetal heart rate and fetal pO2 of oxygen administration to the mother. Am J Obstet Gynecol 1967; 98 (06) 858-870
6 Monitoring IFHR. Nomenclature, interpretation, and general management principles. ACOG Practice Bulletin No. 106. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009; 114: 192-202
7 Saugstad OD, Aasen AO. Plasma hypoxanthine concentrations in pigs. A prognostic aid in hypoxia. Eur Surg Res 1980; 12 (02) 123-129
8 Hamel MS, Hughes BL, Rouse DJ. Whither oxygen for intrauterine resuscitation?. Am J Obstet Gynecol 2015; 212 (04) 461-462
9 Saugstad OD, Aasen AO. Plasma hypoxanthine levels a prognostic aid of tissue hypoxia. Eur Surg Res 1980; 12: 123-129
10 Saugstad OD. Oxygen toxicity in the neonatal period. Acta Paediatr Scand 1990; 79 (10) 881-892
11 Suzuki S, Yoneyama Y, Sawa R, Murata T, Araki T, Power GG. Changes in fetal plasma adenosine and xanthine concentrations during fetal asphyxia with maternal oxygen administration in ewes. Tohoku J Exp Med 2000; 192 (04) 275-281
12 Yamada T, Yoneyama Y, Sawa R, Araki T. Effects of maternal oxygen supplementation on fetal oxygenation and lipid peroxidation following a single umbilical cord occlusion in fetal goats. J Nippon Med Sch 2003; 70 (02) 165-171
13 Bracci R, Perrone S, Buonocore G. Red blood cell involvement in fetal/neonatal hypoxia. Biol Neonate 2001; 79 (3-4): 210-212
14 Klinger G, Beyene J, Shah P, Perlman M. Do hyperoxaemia and hypocapnia add to the risk of brain injury after intrapartum asphyxia?. Arch Dis Child Fetal Neonatal Ed 2005; 90 (01) F49-F52
15 Rabi Y, Rabi D, Yee W. Room air resuscitation of the depressed newborn: a systematic review and meta-analysis. Resuscitation 2007; 72 (03) 353-363
16 Davis PG, Tan A, O'Donnell CPF, Schulze A. Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis. Lancet 2004; 364 (9442): 1329-1333
17 Hamel MS, Anderson BL, Rouse DJ. Oxygen for intrauterine resuscitation: of unproved benefit and potentially harmful. Am J Obstet Gynecol 2014; 211 (02) 124-127
18 Lawes EG, Newman B, Campbell MJ, Irwin M, Dolenska S, Thomas TA. Maternal inspired oxygen concentration and neonatal status for caesarean section under general anaesthesia. Comparison of effects of 33% or 50% oxygen in nitrous oxide. Br J Anaesth 1988; 61 (03) 250-254
19 Perreault C, Blaise GA, Meloche R. Maternal inspired oxygen concentration and fetal oxygenation during caesarean section. Can J Anaesth 1992; 39 (02) 155-157
20 Jozwik M, Sledziewski A, Klubowicz Z, Zak J, Sajewska G, Pietrzycki B. Oxygen administration in labour and cord acid-base status at birth. Med Wieku Rozwoj 2000; 4: 404-411
21 Thorp JA, Trobough T, Evans R, Hedrick J, Yeast JD. The effect of maternal oxygen administration during the second stage of labor on umbilical cord blood gas values: a randomized controlled prospective trial. Am J Obstet Gynecol 1995; 172 (2 Pt 1): 465-474
22 Sirimai K, Atisook R, Boriboonhirusarn D. The correlation of intrapartum maternal oxygen administration and umbilical cord blood gas values. Acta Obstet Gynecol Scand Suppl 1997; 76: 90
23 Qian G, Xu X, Chen L. , et al. The effect of maternal low flow oxygen administration during the second stage of labour on umbilical cord artery pH: a randomised controlled trial. BJOG 2017; 124 (04) 678-685
24 Haydon ML, Gorenberg DM, Nageotte MP. , et al. The effect of maternal oxygen administration on fetal pulse oximetry during labor in fetuses with nonreassuring fetal heart rate patterns. Am J Obstet Gynecol 2006; 195 (03) 735-738
25 Simpson KR, James DC. Efficacy of intrauterine resuscitation techniques in improving fetal oxygen status during labor. Obstet Gynecol 2005; 105 (06) 1362-1368
26 Raghuraman N, Temming LA, Stout MJ, Macones GA, Cahill AG, Tuuli MG. Intrauterine hyperoxemia and risk of neonatal morbidity. Obstet Gynecol 2017; 129 (04) 676-682
27 McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects. J Clin Epidemiol 2014; 67 (03) 267-277