Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, St Louis, Missouri.
Department of Obstetrics and Gynecology, Atrium Health Carolinas Medical Center, Charlotte, North Carolina.
JAMA Pediatr. 2021 Apr 1;175(4):368-376. doi: 10.1001/jamapediatrics.2020.5351.
Supplemental oxygen is commonly administered to pregnant women at the time of delivery to prevent fetal hypoxia and acidemia. There is mixed evidence on the utility of this practice.
To compare the association of peripartum maternal oxygen administration with room air on umbilical artery (UA) gas measures and neonatal outcomes.
Ovid MEDLINE, Embase, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials were searched from February 18 to April 3, 2020. Search terms included labor or obstetric delivery and oxygen therapy and fetal blood or blood gas or acid-base imbalance.
Studies were included if they were randomized clinical trials comparing oxygen with room air at the time of scheduled cesarean delivery or labor in patients with singleton, nonanomalous pregnancies. Studies that did not collect paired umbilical cord gas samples or did not report either UA pH or UA Pao2 results were excluded.
Data were extracted by 2 independent reviewers. The analysis was stratified by the presence or absence of labor at the time of randomization. Data were pooled using random-effects models.
The primary outcome for this review was UA pH. Secondary outcomes included UA pH less than 7.2, UA Pao2, UA base excess, 1- and 5-minute Apgar scores, and neonatal intensive care unit admission.
The meta-analysis included 16 randomized clinical trials (n = 1078 oxygen group and n = 974 room air group). There was significant heterogeneity among the studies (I2 = 49.88%; P = .03). Overall, oxygen administration was associated with no significant difference in UA pH (weighted mean difference, 0.00; 95% CI, -0.01 to 0.01). Oxygen use was associated with an increase in UA Pao2 (weighted mean difference, 2.57 mm Hg; 95% CI, 0.80-4.34 mm Hg) but no significant difference in UA base excess, UA pH less than 7.2, Apgar scores, or neonatal intensive care unit admissions. Umbilical artery pH values remained similar between groups after accounting for the risk of bias, type of oxygen delivery device, and fraction of inspired oxygen. After stratifying by the presence or absence of labor, oxygen administration in women undergoing scheduled cesarean delivery was associated with increased UA Pao2 (weighted mean difference, 2.12 mm Hg; 95% CI, 0.09-4.15 mm Hg) and a reduction in the incidence of UA pH less than 7.2 (relative risk, 0.63; 95% CI, 0.43-0.90), but these changes were not noted among those in labor (Pao2: weighted mean difference, 3.60 mm Hg; 95% CI, -0.30 to 7.49 mm Hg; UA pH<7.2: relative risk, 1.34; 95% CI, 0.58-3.11).
This systematic review and meta-analysis suggests that studies to date showed no association between maternal oxygen and a clinically relevant improvement in UA pH or other neonatal outcomes.
在分娩时，通常会给孕妇补充氧气，以防止胎儿缺氧和酸中毒。关于这种做法的实用性存在混合证据。
比较围产期母亲吸氧与吸入空气对脐动脉（UA）气体测量值和新生儿结局的影响。
从 2020 年 2 月 18 日至 4 月 3 日，检索了 Ovid MEDLINE、Embase、Scopus、ClinicalTrials.gov 和 Cochrane 对照试验中心注册库，检索词包括分娩或产科分娩和氧气治疗以及胎儿血液或血气或酸碱失衡。
如果随机对照试验将接受择期剖宫产或有单胎、非畸形妊娠的产妇的氧气与空气进行比较，则纳入研究。未收集配对脐动脉血气样本或未报告 UA pH 或 UA Pao2 结果的研究被排除在外。
由 2 名独立评审员提取数据。分析根据随机分组时是否存在分娩进行分层。使用随机效应模型对数据进行汇总。
本综述的主要结局是 UA pH。次要结局包括 UA pH 值<7.2、UA Pao2、UA 碱剩余、1 分钟和 5 分钟 Apgar 评分和新生儿重症监护病房入院。
荟萃分析纳入了 16 项随机临床试验（n = 1078 例吸氧组和 n = 974 例空气组）。研究之间存在显著异质性（I2 = 49.88%；P =.03）。总体而言，吸氧与 UA pH 无显著差异（加权均数差，0.00；95%置信区间，-0.01 至 0.01）。使用氧气与 UA Pao2 增加有关（加权均数差，2.57 毫米汞柱；95%置信区间，0.80-4.34 毫米汞柱），但 UA 碱剩余、UA pH 值<7.2、Apgar 评分或新生儿重症监护病房入院率无显著差异。在考虑偏倚风险、氧气输送装置类型和吸入氧分数后，两组的 UA pH 值仍相似。在分层考虑是否存在分娩后，计划行剖宫产的女性接受氧气治疗与 UA Pao2 增加有关（加权均数差，2.12 毫米汞柱；95%置信区间，0.09-4.15 毫米汞柱），与 UA pH 值<7.2 的发生率降低有关（相对风险，0.63；95%置信区间，0.43-0.90），但在分娩的女性中未观察到这些变化（Pao2：加权均数差，3.60 毫米汞柱；95%置信区间，-0.30 至 7.49 毫米汞柱；UA pH 值<7.2：相对风险，1.34；95%置信区间，0.58-3.11）。
本系统评价和荟萃分析表明，迄今为止的研究表明，母亲吸氧与 UA pH 或其他新生儿结局的临床相关改善之间没有关联。
