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Effect of long-duration oxygen vs room air during labor on umbilical cord venous partial pressure of oxygen: a randomized controlled trial

      Background

      There are limited data to guide the duration and dose of oxygen supplementation for pregnant women undergoing labor.

      Objective

      To assess the effect of maternal long-duration high-concentration oxygen administration during labor on umbilical cord venous partial pressure of oxygen.

      Study Design

      This randomized clinical trial was conducted between January and October of 2021 in the obstetrics wards of 3 tertiary teaching hospitals in Beijing, China. Women undergoing the latent phase of labor with no existing medical conditions or obstetrical complications who were admitted for delivery were eligible. The women who met inclusion criteria with category I fetal heart rate tracings in labor were randomized in a 1:1 ratio to oxygen or room air. The oxygen group received 10 L of oxygen per minute by simple, tight-fitting face mask until delivery. The room-air group received room air only, without a face mask. The primary outcome was the umbilical cord venous partial pressure of oxygen.

      Results

      A total of 661 women were screened, and 521 were excluded; 140 participants with category I fetal heart rate tracings were enrolled and randomized to oxygen (N=70) or room air (N=70). A total of 135 women with valid paired umbilical cord venous and arterial gas values were included in the umbilical cord venous partial pressure of oxygen and arterial pH analyses. All 140 women were included in the fetal heart rate tracings analysis. Baseline characteristics were similar between the oxygen and room-air groups. The duration of oxygen exposure was approximately 322±147 minutes. There were no differences between the oxygen and room-air groups in the umbilical cord venous partial pressure of oxygen (mean difference, 1.1 mm Hg; 95% confidence interval, −1.0 to 3.2; P=.318) or the proportion of participants with category II fetal heart rate tracings (81.4% vs 78.6%; relative risk, 1.04; 95% confidence interval, 0.88–1.22; P=.672). However, the umbilical cord arterial pH was significantly lower in the oxygen group than in the room-air group (median, 7.23; interquartile range, 7.20–7.27 vs median 7.27; interquartile range, 7.20–7.30; P=.005).

      Conclusion

      Maternal long-duration high-concentration oxygen administration during labor did not affect either the umbilical cord venous partial pressure of oxygen or fetal heart rate pattern distribution but resulted in a deterioration of the umbilical cord arterial pH at birth.

      Key words

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      References

        • Hamel M.S.
        • Anderson B.L.
        • Rouse D.J.
        Oxygen for intrauterine resuscitation: of unproved benefit and potentially harmful.
        Am J Obstet Gynecol. 2014; 211: 124-127
        • Reddy U.M.
        • Weiner S.J.
        • Saade G.R.
        • et al.
        Intrapartum resuscitation interventions for category II fetal heart rate tracings and improvement to category I.
        Obstet Gynecol. 2021; 138: 409-416
        • Fawole B.
        • Hofmeyr G.J.
        Maternal oxygen administration for fetal distress.
        Cochrane Database Syst Rev. 2012; 12: CD000136
        • Raghuraman N.
        • Temming L.A.
        • Doering M.M.
        • et al.
        Maternal oxygen supplementation compared with room air for intrauterine resuscitation: a systematic review and meta-analysis.
        JAMA Pediatr. 2021; 175: 368-376
        • Smit B.
        • Smulders Y.M.
        • Eringa E.C.
        • et al.
        Effects of hyperoxia on vascular tone in animal models: systematic review and meta-analysis.
        Crit Care. 2018; 22: 189
        • Smit B.
        • Smulders Y.M.
        • van der Wouden J.C.
        • Oudemans-van Straaten H.M.
        • Spoelstra-de Man A.M.E.
        Hemodynamic effects of acute hyperoxia: systematic review and meta-analysis.
        Crit Care. 2018; 22: 45
        • McHugh A.
        • El-Khuffash A.
        • Bussmann N.
        • Doherty A.
        • Franklin O.
        • Breathnach F.
        Hyperoxygenation in pregnancy exerts a more profound effect on cardiovascular hemodynamics than is observed in the nonpregnant state.
        Am J Obstet Gynecol. 2019; 220: 397.e1-397.e18
        • 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.
        • Boriboonhirunsarn D.
        The correlation of intrapartum maternal oxygen administration and umbilical cord blood gas values.
        Acta Obstet Gynecol Scand Suppl. 1997; 76: 90
        • 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: 678-685
        • Raghuraman N.
        • Wan L.
        • Temming L.A.
        • et al.
        Effect of oxygen vs room air on intrauterine fetal resuscitation: a randomized noninferiority clinical trial.
        JAMA Pediatr. 2018; 172: 818-823
        • Moors S.
        • Bullens L.M.
        • van Runnard Heimel P.J.
        • et al.
        The effect of intrauterine resuscitation by maternal hyperoxygenation on perinatal and maternal outcome: a randomized controlled trial.
        Am J Obstet Gynecol MFM. 2020; 2: 100102
        • Raghuraman N.
        • López J.D.
        • Carter E.B.
        • et al.
        The effect of intrapartum oxygen supplementation on category II fetal monitoring.
        Am J Obstet Gynecol. 2020; 223: 905.e1-905.e7
        • Watkins V.Y.
        • Martin S.
        • Macones G.A.
        • Tuuli M.G.
        • Cahill A.G.
        • Raghuraman N.
        The duration of intrapartum supplemental oxygen administration and umbilical cord oxygen content.
        Am J Obstet Gynecol. 2020; 223: 440.e1-440.e7
        • Dildy G.A.
        • Clark S.L.
        • Loucks C.A.
        Intrapartum fetal pulse oximetry: the effects of maternal hyperoxia on fetal arterial oxygen saturation.
        Am J Obstet Gynecol. 1994; 171: 1120-1124
        • Simpson K.R.
        • James D.C.
        Efficacy of intrauterine resuscitation techniques in improving fetal oxygen status during labor.
        Obstet Gynecol. 2005; 105: 1362-1368
        • Haydon M.L.
        • Gorenberg D.M.
        • Nageotte M.P.
        • 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: 735-738
        • Aldrich C.J.
        • Wyatt J.S.
        • Spencer J.A.
        • Reynolds E.O.
        • Delpy D.T.
        The effect of maternal oxygen administration on human fetal cerebral oxygenation measured during labour by near infrared spectroscopy.
        Br J Obstet Gynaecol. 1994; 101: 509-513
        • Huen I.
        • Morris D.M.
        • Wright C.
        • Sibley C.P.
        • Naish J.H.
        • Johnstone E.D.
        Absence of PO2 change in fetal brain despite PO2 increase in placenta in response to maternal oxygen challenge.
        BJOG. 2014; 121: 1588-1594
        • You W.
        • Andescavage N.N.
        • Kapse K.
        • Donofrio M.T.
        • Jacobs M.
        • Limperopoulos C.
        Hemodynamic responses of the placenta and brain to maternal hyperoxia in fetuses with congenital heart disease by using blood oxygen-level dependent MRI.
        Radiology. 2020; 294: 141-148
        • Morris D.M.
        • Ross J.A.
        • McVicar A.
        • et al.
        Changes in foetal liver T2∗ measurements by MRI in response to maternal oxygen breathing: application to diagnosing foetal growth restriction.
        Physiol Meas. 2010; 31: 1137-1146
        • Wang C.
        • Gao Z.
        Internal medicine: respiratory and critical care medicine. Beijing, People’s Republic of China.
        People’s Health Publishing House, 2016
        • ACOG Practice Bulletin No. 106
        ACOG Practice Bulletin No. 106: intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles.
        Obstet Gynecol. 2009; 114: 192-202
        • ACOG Committee on Obstetric Practice
        ACOG Committee Opinion No. 348, November 2006: umbilical cord blood gas and acid-base analysis.
        Obstet Gynecol. 2006; 108: 1319-1322
        • Monneret D.
        • Desmurs L.
        • Zaepfel S.
        • Chardon L.
        • Doret-Dion M.
        • Cartier R.
        Reference percentiles for paired arterial and venous umbilical cord blood gases: an indirect nonparametric approach.
        Clin Biochem. 2019; 67: 40-47
        • Jackson M.
        • Holmgren C.M.
        • Esplin M.S.
        • Henry E.
        • Varner M.W.
        Frequency of fetal heart rate categories and short-term neonatal outcome.
        Obstet Gynecol. 2011; 118: 803-808
        • Chatmongkolchart S.
        • Prathep S.
        Supplemental oxygen for caesarean section during regional anaesthesia.
        Cochrane Database Syst Rev. 2016; 2016: CD006161
        • Shao X.
        • Ye H.
        • Qiu X.
        Practice of neonatology.
        5th ed. People’s Health Publishing House, Beijing, People’s Republic of China2019
        • Wang T.
        Physiology.
        9th ed. People’s Health Publishing House, Beijing, People’s Republic of China2018
        • Yeh P.
        • Emary K.
        • Impey L.
        The relationship between umbilical cord arterial pH and serious adverse neonatal outcome: analysis of 51,519 consecutive validated samples.
        BJOG. 2012; 119: 824-831
        • Johnson G.J.
        • Salmanian B.
        • Denning S.G.
        • Belfort M.A.
        • Sundgren N.C.
        • Clark S.L.
        Relationship Between umbilical cord gas values and neonatal outcomes: implications for electronic fetal heart rate monitoring.
        Obstet Gynecol. 2021; 138: 366-373
      1. Higgins J.P.T. Thomas J. Chandler J. Cumpston M. Li T. Page M.J. Welch V.A. Cochrane Handbook for Systematic Reviews of Interventions. 2nd Edition. John Wiley & Sons, Chichester, United Kingdom2019

      References

        • 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.
        • Boriboonhirunsarn D.
        The correlation of intrapartum maternal oxygen administration and umbilical cord blood gas values.
        Acta Obstet Gynecol Scand Suppl. 1997; 76: 90
        • 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: 678-685
        • Raghuraman N.
        • Wan L.
        • Temming L.A.
        • et al.
        Effect of oxygen vs room air on intrauterine fetal resuscitation: A randomized noninferiority clinical trial.
        JAMA Pediatr. 2018; 172: 818-823

      Further reading

        • 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.
        • Boriboonhirunsarn D.
        The correlation of intrapartum maternal oxygen administration and umbilical cord blood gas values.
        Acta Obstet Gynecol Scand Suppl. 1997; 76: 90
        • 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: 678-685
        • Raghuraman N.
        • Wan L.
        • Temming L.A.
        • et al.
        Effect of oxygen vs room air on intrauterine fetal resuscitation: A randomized noninferiority clinical trial.
        JAMA Pediatr. 2018; 172: 818-823

      References

        • Hamel M.S.
        • Anderson B.L.
        • Rouse D.J.
        Oxygen for intrauterine resuscitation: of unproved benefit and potentially harmful.
        Am J Obstet Gynecol. 2014; 211: 124-127
        • Reddy U.M.
        • Weiner S.J.
        • Saade G.R.
        • et al.
        Intrapartum resuscitation interventions for Category II fetal heart rate tracings and improvement to Category I.
        Obstet Gynecol. 2021; 138: 409-416
        • Fawole B.
        • Hofmeyr G.J.
        Maternal oxygen administration for fetal distress.
        Cochrane Database Syst Rev. 2012; 12: CD000136
        • Raghuraman N.
        • Temming L.A.
        • Doering M.M.
        • et al.
        Maternal oxygen supplementation compared With room air for intrauterine resuscitation: A systematic review and meta-analysis.
        JAMA Pediatr. 2021; 175: 368-376
        • Smit B.
        • Smulders Y.M.
        • Eringa E.C.
        • et al.
        Effects of hyperoxia on vascular tone in animal models: systematic review and meta-analysis.
        Crit Care. 2018; 22: 189
        • Smit B.
        • Smulders Y.M.
        • van der Wouden J.C.
        • Oudemans-van Straaten H.M.
        • Spoelstra-de Man A.M.E.
        Hemodynamic effects of acute hyperoxia: systematic review and meta-analysis.
        Crit Care. 2018; 22: 45
        • McHugh A.
        • El-Khuffash A.
        • Bussmann N.
        • Doherty A.
        • Franklin O.
        • Breathnach F.
        Hyperoxygenation in pregnancy exerts a more profound effect on cardiovascular hemodynamics than is observed in the nonpregnant state.
        Am J Obstet Gynecol. 2019; 220: 397.e1-397.e8
        • 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.
        • Boriboonhirunsarn D.
        The correlation of intrapartum maternal oxygen administration and umbilical cord blood gas values.
        Acta Obstet Gynecol Scand Suppl. 1997; 76: 90
        • 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: 678-685
        • Raghuraman N.
        • Wan L.
        • Temming L.A.
        • et al.
        Effect of oxygen vs room air on intrauterine fetal resuscitation: A randomized noninferiority clinical trial.
        JAMA Pediatr. 2018; 172: 818-823
        • Moors S.
        • Bullens L.M.
        • van Runnard Heimel P.J.
        • et al.
        The effect of intrauterine resuscitation by maternal hyperoxygenation on perinatal and maternal outcome: a randomized controlled trial.
        Am J Obstet Gynecol MFM. 2020; 2: 100102
        • Raghuraman N.
        • López J.D.
        • Carter E.B.
        • et al.
        The effect of intrapartum oxygen supplementation on category II fetal monitoring.
        Am J Obstet Gynecol. 2020; 223: 905.e1-905.e7
        • Watkins V.Y.
        • Martin S.
        • Macones G.A.
        • Tuuli M.G.
        • Cahill A.G.
        • Raghuraman N.
        The duration of intrapartum supplemental oxygen administration and umbilical cord oxygen content.
        Am J Obstet Gynecol. 2020; 223: 440.e1-440.e7
        • Dildy G.A.
        • Clark S.L.
        • Loucks C.A.
        Intrapartum fetal pulse oximetry: the effects of maternal hyperoxia on fetal arterial oxygen saturation.
        Am J Obstet Gynecol. 1994; 171: 1120-1124
        • Simpson K.R.
        • James D.C.
        Efficacy of intrauterine resuscitation techniques in improving fetal oxygen status during labor.
        Obstet Gynecol. 2005; 105: 1362-1368
        • Haydon M.L.
        • Gorenberg D.M.
        • Nageotte M.P.
        • 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: 735-738
        • Aldrich C.J.
        • Wyatt J.S.
        • Spencer J.A.
        • Reynolds E.O.
        • Delpy D.T.
        The effect of maternal oxygen administration on human fetal cerebral oxygenation measured during labour by near infrared spectroscopy.
        Br J Obstet Gynaecol. 1994; 101: 509-513
        • Huen I.
        • Morris D.M.
        • Wright C.
        • Sibley C.P.
        • Naish J.H.
        • Johnstone E.D.
        Absence of PO2 change in fetal brain despite PO2 increase in placenta in response to maternal oxygen challenge.
        BJOG. 2014; 121: 1588-1594
        • You W.
        • Andescavage N.N.
        • Kapse K.
        • Donofrio M.T.
        • Jacobs M.
        • Limperopoulos C.
        Hemodynamic responses of the placenta and brain to maternal hyperoxia in fetuses with congenital heart disease by using blood oxygen-level dependent MRI.
        Radiology. 2020; 294: 141-148
        • Morris D.M.
        • Ross J.A.
        • McVicar A.
        • et al.
        Changes in foetal liver T2∗ measurements by MRI in response to maternal oxygen breathing: application to diagnosing foetal growth restriction.
        Physiol Meas. 2010; 31: 1137-1146
        • Wang C.
        • Gao Z.
        Internal medicine: respiratory and critical care medicine. Beijing, People’s Republic of China.
        People’s Health Publishing House, 2016
        • ACOG Practice Bulletin No. 106
        ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles.
        Obstet Gynecol. 2009; 114: 192-202
        • ACOG Committee on Obstetric Practice
        ACOG Committee Opinion No. 348, November 2006: umbilical cord blood gas and acid-base analysis.
        Obstet Gynecol. 2006; 108: 1319-1322
        • Monneret D.
        • Desmurs L.
        • Zaepfel S.
        • Chardon L.
        • Doret-Dion M.
        • Cartier R.
        Reference percentiles for paired arterial and venous umbilical cord blood gases: an indirect nonparametric approach.
        Clin Biochem. 2019; 67: 40-47
        • Chatmongkolchart S.
        • Prathep S.
        Supplemental oxygen for caesarean section during regional anaesthesia.
        Cochrane Database Syst Rev. 2016; 2016: CD006161