Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA.
Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA.
Am J Obstet Gynecol MFM. 2021 Jul;3(4):100374. doi: 10.1016/j.ajogmf.2021.100374. Epub 2021 Apr 6.
This study aimed to determine if maternal intrapartum administration of oxygen altered the rate of cesarean delivery compared with room air.
This study was a systematic review and meta-analysis of randomized controlled trials. Searches were performed in MEDLINE, OVID, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials using a combination of key words related to "pregnant patients," "labor," "oxygen," "fetus," "newborn," and pregnancy outcomes from database inception until April 2020. The study was registered in PROSPERO (registration number CRD42020162110).
The inclusion criteria were randomized controlled trials of maternal administration of oxygen compared with room air in labor. The exclusion criteria were quasi-randomized trials and oxygen administered for planned cesarean deliveries. The primary outcome was the rate of cesarean delivery. Secondary maternal and neonatal outcomes, including cord gas values, were analyzed.
The Cochrane Handbook guidelines were used to assess bias in trials. To calculate the relative risk or mean differences with confidence intervals, a random-effects model was employed. Subgroup analyses were performed for women who received oxygen for nonreassuring fetal heart rate monitoring or prophylactically.
Five randomized controlled trials, including 768 women, were included in the meta-analysis, 3 using prophylactic oxygen and 2 using oxygen for nonreassuring fetal heart rate monitoring. The risk of bias was generally considered low. There was no statistically significant difference in the rate of cesarean delivery between patients administered oxygen and patients provided room air (16 of 365 [4.4%] vs 11 of 379 [2.9%]; risk ratio 1.5; 95% confidence interval, 0.7-3.3). In addition, there were no statistically significant differencs in the rates of cesarean delivery for nonreassuring fetal heart rate monitoring, operative vaginal deliveries, Apgar scores of <7, neonatal intensive care unit admissions, or cord blood gas values. There were no statistically significant difference when analyzing oxygen for nonreassuring fetal heart rate monitoring alone or prophylactic oxygen alone. Data regarding FHT is mixed, with one study suggesting an improvement and three suggesting no change.
Maternal intrapartum oxygen administration was not associated with any differences in the rate of cesarean delivery or any secondary outcomes compared with room air overall and in the subgroups of therapeutic (for nonreassuring fetal heart rate monitoring) or prophylactic administration in this meta-analysis. Large randomized controlled trials are necessary to further examine any possible benefits or harms of oxygen administration in labor, particularly for nonreassuring fetal heart rate monitoring.
本研究旨在确定与空气相比，产妇产程中使用氧气是否会改变剖宫产率。
本研究为系统评价和荟萃分析随机对照试验。使用与“孕妇”、“分娩”、“氧气”、“胎儿”、“新生儿”和妊娠结局相关的关键词，在 MEDLINE、OVID、Scopus、ClinicalTrials.gov 和 Cochrane 对照试验中心注册库中进行了检索，检索时间从数据库建立到 2020 年 4 月。该研究在 PROSPERO（注册号 CRD42020162110）中进行了注册。
产妇在分娩时使用氧气与空气相比的随机对照试验。排除标准为半随机试验和为计划性剖宫产而给予的氧气。主要结局为剖宫产率。分析了次要的产妇和新生儿结局，包括脐带血气值。
使用 Cochrane 手册指南评估试验中的偏倚。使用随机效应模型计算相对风险或均值差异的置信区间。对因非胎儿心率监测不良而接受氧气或预防性接受氧气的女性进行了亚组分析。
纳入了 5 项随机对照试验，共 768 名女性，其中 3 项使用预防性氧气，2 项使用非胎儿心率监测不良的氧气。偏倚风险通常被认为较低。接受氧气的患者与接受空气的患者剖宫产率无统计学差异（365 例中的 16 例[4.4%]与 379 例中的 11 例[2.9%]；风险比 1.5；95%置信区间，0.7-3.3）。此外，非胎儿心率监测不良、经阴道分娩、Apgar 评分<7、新生儿重症监护病房入院率或脐带血血气值的剖宫产率也无统计学差异。单独分析非胎儿心率监测不良的氧气或预防性氧气时，差异也无统计学意义。关于 FHT 的数据存在差异，一项研究表明有所改善，三项研究表明无变化。
与空气相比，产妇产程中使用氧气总体上以及在治疗性（用于非胎儿心率监测不良）或预防性使用的亚组中，与剖宫产率或任何次要结局均无差异。需要进行大型随机对照试验来进一步检查分娩中使用氧气的任何可能的益处或危害，特别是对于非胎儿心率监测不良的情况。
