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

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

› Author Affiliations

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

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