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 This is a retrospective observational study conducted at a single tertiary care center
from January 2019 to June 2021. All laboring deliveries during the study period were
reviewed and eligible participants included singleton or twin pregnancies between
23 and 42 weeks gestational age with persistent category II tracings. Known major
fetal anomalies, contraindications to labor, and maternal indication for O2 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.
Keywords
implementation - fetal resuscitation - category II fetal heart tracing - maternal
oxygenation - fetal acidemia - de-implementation
