ACOG Addresses Use of Oxygen for Fetal Indications During Labor
ACOG has released a Practice Advisory regarding the use of oxygen supplementation in the setting of category II or III fetal heart tracings. The Advisory supplements the Practice Bulletin regarding intrapartum fetal heart rate monitoring and recommends against supplemental oxygen. The Advisory is based on recent literature, and focuses on a key paper by Raghuraman et al.
Maternal Oxygen Supplementation Compared With Room Air for Intrauterine Resuscitation (JAMA Pediatrics, 2021)
The research team assessed whether there was an association between umbilical artery (UA) gas measures and neonatal outcomes with peripartum maternal oxygen administration vs room air
Systematic review and meta-analysis
Study inclusion criteria
Studies that compared oxygen with room air at the time of scheduled cesarean delivery or labor
Participants were patients with singleton, nonanomalous pregnancies
Umbilical artery (UA) pH
UA pH <7.2 | UA PaO2 | UA base excess | Apgar scores (1 and 5 min) | NICU
Supplemental oxygen therapy at delivery was not associated with improvement in umbilical artery pH or other neonatal outcomes
An associated editorial to the above study concludes
While maternal oxygen administration to the normally oxygenated mother in labor is likely as innocuous as it is useless, concern for the practice of evidence-based medicine would seem to suggest that recommendations for its use in 2 million to 3 million women annually may be inappropriate
The ACOG Practice Advisory states
Based on this body of research, routine use of oxygen supplementation in individuals with normal oxygen saturation is not recommended for fetal intrauterine resuscitation
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