Clinical opinion Obstetrics| Volume 211, ISSUE 2, P124-127, August 2014

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Oxygen for intrauterine resuscitation: of unproved benefit and potentially harmful

Published:January 10, 2014DOI:
      Maternal oxygen is often given to laboring women to improve fetal metabolic status or in an attempt to alleviate nonreassuring fetal heart rate patterns. However, the only 2 randomized trials investigating the use of maternal oxygen supplementation in laboring women do not support that such supplementation is likely to be of benefit to the fetus. And by increasing free radical activity, maternal oxygen supplementation may even be harmful. Based on a review of the available literature, we conclude that until it is studied properly in a randomized clinical trial, maternal oxygen supplementation in labor should be reserved for maternal hypoxia, and should not be considered an indicated intervention for nonreassuring fetal status.

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        • American College of Obstetricians and Gynecologists
        Management of intrapartum fetal heart rate tracings. ACOG practice bulletin no. 116.
        Obstet Gynecol. 2010; 116: 1232-1240
        • Bloom S.L.
        • Spong C.Y.
        • Thom E.
        • et al.
        Fetal pulse oximetry and cesarean delivery.
        N Engl J Med. 2006; 355: 2195-2202
        • Fawole B.
        • Hofmeyr G.J.
        Maternal oxygen administration for fetal distress.
        Cochrane Database Syst Rev. 2012; 12: CD0000136
        • Meschia G.
        Fetal oxygenation and maternal ventilation.
        Clin Chest Med. 2011; 32: 15-19
        • Walker J.
        • Turnbull E.P.
        Hemoglobin and red cells in the human fetus and their relation to the oxygen content of the blood in the vessels of the umbilical cord.
        Lancet. 1953; 2: 312-318
        • Milman N.
        • Bergholt T.
        • Byg K.
        • Eriksen L.
        • Hvas A.
        Reference intervals for hematological variables during normal pregnancy and postpartum in 434 healthy Danish women.
        Eur J Haematol. 2007; 79: 39-46
        • Beaton G.H.
        Iron needs during pregnancy: do we need to rethink our targets?.
        Am J Clin Nutr. 2000; 72: 265S-271S
        • Wilkening R.B.
        • Meschia G.
        Fetal oxygen uptake, oxygenation and acid-base balance as a function of uterine blood flow.
        Am J Physiol Heart Circ Physiol. 1983; 244: H749-H755
        • James L.S.
        • Morishima H.O.
        • Daniel S.S.
        • Bowe E.T.
        • Cohen H.
        • Niemann W.H.
        Mechanism of late deceleration of the fetal heart rate.
        Am J Obstet Gynecol. 1972; 113: 578-582
        • Murata Y.
        • Martine C.B.
        • Ikenoue T.
        • et al.
        Fetal heart rate accelerations and late decelerations during the course of intrauterine death in chronically catheterized rhesus monkeys.
        Am J Obstet Gynecol. 1982; 144: 218-223
        • Althabe O.
        • Schwarcz R.L.
        • Pose S.V.
        • 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: 858-870
        • Khazin A.F.
        • Hon E.H.
        • Hehre F.W.
        Effects of maternal hyperoxia on the fetus.
        Am J Obstet Gynecol. 1971; 109: 628-637
        • Kubli F.W.
        • Hon E.H.
        • Khazin A.F.
        • Takemura H.
        Observations on heart rate and pH in the human fetus during labor.
        Am J Obstet Gynecol. 1969; 107: 1190-1206
        • Newman W.
        • McKinnon L.
        • Phillips L.
        • Paterson P.
        • Wood C.
        Oxygen transfer from mother to fetus during labor.
        Am J Obstet Gynecol. 1967; 99: 61-69
        • Ramanathan S.
        • Gandhi S.
        • Arismendy A.
        • Chalon J.
        • Turndoff H.
        Oxygen transfer from mother to fetus during cesarean section under epidural anesthesia.
        Anesth Analg. 1982; 61: 576-581
        • Thorp J.A.
        • Trobough T.
        • Evans R.
        • Hedrick J.
        • Yeast J.D.
        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: 465-474
        • Sirimai K.
        • Atisook R.
        • Boriboonhirunsam D.
        The correlation of intrapartum maternal oxygen administration and umbilical cord blood gas values.
        Acta Obstet Gynecol Scand Suppl. 1997; 76: 90
        • Morishima H.O.
        • Daniel S.S.
        • Richards R.T.
        • James L.S.
        The effect of increased maternal Pao2 upon the fetus during labor.
        Am J Obstet Gynecol. 1975; 123: 257-264
        • Polvi H.J.
        • Pirhonen J.P.
        • Erkkola R.U.
        The hemodynamic effects of maternal hypo- and hyperoxygenation in healthy term pregnancies.
        Obstet Gynecol. 1995; 86: 795-799
        • Khaw K.S.
        • Wang C.C.
        • Ngan Kee W.D.
        • Pang C.P.
        • Rogers M.S.
        Effects of high inspired oxygen fraction during elective cesarean section under spinal anesthesia on maternal and fetal oxygenation and lipid peroxidation.
        Br J Anaesth. 2002; 88: 18-23
        • Suzuki S.
        • Yoneyama Y.
        • Sawa R.
        • Murata T.
        • Araki T.
        • Power G.G.
        Changes in fetal plasma adenosine and xanthine concentrations during fetal asphyxia with maternal oxygen administration in ewes.
        Tohoku J Exp Med. 2000; 192: 275-281
        • Yamada T.
        • Yoneyama Y.
        • Sawa R.
        • Araki T.
        Effects of maternal oxygen supplementation on fetal oxygenation and lipid peroxidation following a single umbilical cod occlusion in fetal goats.
        J Nippon Med Sch. 2003; 70: 165-171
        • Nesterenko T.H.
        • Acun C.
        • Mohamed M.A.
        • et al.
        Is it a safe practice to administer oxygen during uncomplicated delivery? A randomized controlled trial.
        Early Human Dev. 2012; 88: 677-681
        • Sola A.
        • Saldeno Y.P.
        • Favareto V.
        Clinical practices in neonatal oxygenation: where have we failed? What can we do?.
        J Perinatol. 2008; 28: S28-S34
        • Davis P.G.
        • Tan A.
        • O'Donnell C.P.R.
        • Schulze A.
        Resuscitation of newborn infants with 100% oxygen or air: a systematic review and meta-analysis.
        Lancet. 2004; 364: 1329-1333
        • Rabi Y.
        • Rabi D.
        • Yee W.
        Room air resuscitation of the depressed newborn: a systematic review and meta-analysis.
        Resuscitation. 2007; 72: 353-363
        • Kattwinkle J.
        • Perlman J.M.
        • Aziz K.
        • et al.
        Neonatal resuscitation: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Pediatrics. 2010; 126: e1400-e1413
        • McCord J.M.
        Oxygen-derived free radicals in postischemic tissue injury.
        N Engl J Med. 1985; 312: 159-163
        • Klinger G.
        • Beyene J.
        • Shah P.
        • Perlman M.
        Do hyperoxemia and hypocapnia add to the risk of brain injury after intrapartum asphyxia?.
        Arch Dis Child Fetal Neonatal Ed. 2005; 90: F49-F52
        • Wang W.
        • Pang C.C.P.
        • Rogers M.S.
        • Chang A.M.Z.
        Lipid peroxidation in cord blood at birth.
        Am J Obstet Gynecol. 1996; 174: 62-65
        • Dede F.S.
        • Guney Y.
        • Dede H.
        • Koca C.
        • Dilbaz B.
        • Bilgihan A.
        Lipid peroxidation and antioxidant activity in patients in labor with nonreassuring fetal status.
        Eur J Obstet Gynecol Reprod Biol. 2006; 124: 27-31
        • Ramin S.M.
        • Gilstrap L.C.
        • Leveno K.J.
        • Little B.B.
        Umbilical artery acid-base status in the preterm infant.
        Obstet Gynecol. 1989; 74: 256-258
      1. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). A randomized trial of fetal ECG ST segment and T wave analysis as an adjunct to electronic fetal heart rate monitoring (STAN). [Internet]. Bethesda, MD: National Library of Medicine (US). 2000-NLM Identifier: NCT01131260. Available at: STAN&rank=1. Accessed Dec. 23, 2013.

      Linked Article

      • Maternal oxygen administration for intrauterine resuscitation
        American Journal of Obstetrics & GynecologyVol. 212Issue 3
        • Preview
          It was with great interest that we read “Oxygen for intrauterine resuscitation: of unproven benefit and potentially harmful.”1 We commend the authors for their attention to this topic. However, it should be noted that a plethora of evidence was either not cited or disregarded in order to draw the authors’ conclusions. The opinions expressed in the article stand in admittedly stark contrast to current practice and recommendations of the professional organizations American Congress of Obstetricians and Gynecologists; Association of Women's Health, Obstetric and Neonatal Nurses; and American College of Nurse-Midwives.
        • Full-Text
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      • Maternal oxygen use during labor
        American Journal of Obstetrics & GynecologyVol. 212Issue 3
        • Preview
          We read with interest the Clinical Opinion of Hamel et al1 in which the authors suggest that supplemental maternal oxygen should only be used for conditions of maternal and not fetal hypoxemia. Although the article raises important points, we believe there are indications of maternal oxygen for treatment of fetal hypoxemia. The authors note 2 randomized studies, containing relatively low numbers of laboring patients, which failed to demonstrate a fetal benefit. Notably, both studies reported no difference in umbilical cord pH among the groups.
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