Work

Deimplementation of Routine Maternal Oxygen Supplementation for Intrauterine Fetal Resuscitation: A Retrospective Cohort Study

Year: 2024

Type: article

Abstract: OBJECTIVE: Current practice guidelines for laboring patients with category II intrapartum tracings recommend maternal oxygen supplementation despite emerging randomized data challenging its benefit and utility. We aim to validate that de-implementing maternal oxygen supplementation for fetal resuscitation did not increase the risk of neonatal acidemia in a real-world setting. STUDY DESIGN: supplementation, including active coronavirus disease 2019, were excluded. Cohorts were allocated based on the time of delivery. Those occurring prior to our hospital policy change were identified as historical controls and deliveries after April 1, 2020, as the postdeimplementation cohort. The primary outcome was fetal acidemia, defined as umbilical cord pH < 7.2. Secondary outcomes included severe acidemia (pH < 7.0), 5-minute Apgar score <4, and neonatal intensive care admission. Regression analyses controlling for known variables associated with neonatal acidemia generated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS: Among 9,088 deliveries during the study period, 1,162 tracings were flagged as persistent category II, including 681 (59%) in the postintervention group. The two cohorts had comparable baseline and obstetric characteristics. No difference in neonatal acidemia was observed between the postdeimplementation group and historical controls (13.8 vs. 15.4%, aOR = 0.87, 95% CI: 0.62, 1.22). Severe acidemia, 5-minute Apgar <4, and neonatal intensive care admission were not increased in the postdeimplementation group. CONCLUSION: De-implementation of routine maternal oxygen supplementation for fetal resuscitation did not increase the likelihood of neonatal acidemia in a real-world setting, validating guidelines recommending against the intervention. KEY POINTS: · De-implementation of maternal O2 supplementation for fetal resuscitation did not increase acidemia.. · Real-world experience validates experimental findings regarding maternal oxygenation.. · Other perinatal outcomes reflected no difference in fetal acidemia..

Source: American Journal of Perinatology

DOI: 10.1055/a-2405-1687

Authors: Sarah E. Chisholm, Mariella Gastanaduy, Adrem Elmayan, Frank B. Williams

Institutions: Dartmouth–Hitchcock Medical Center, Ochsner Health System, The University of Queensland, Ochsner Medical Center

Language: English

Topic: Maternal and Perinatal Health Interventions

Subfield: Obstetrics and Gynecology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: bronze

OpenAlex ID: W4401988682