Bart Yossi, Meyer Raanan, Moran Orit, Tsur Abraham, Kassif Eran, Mohr-Sasson Aya, Hamilton Emily, Sivan Eyal, Yinon Yoav, Mazaki-Tovi Shali, Yoeli Rakefet
Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.
Am J Perinatol. 2024 May;41(S 01):e1479-e1485. doi: 10.1055/a-2051-4047. Epub 2023 Mar 9.
This study aimed to evaluate whether the suspension of intrapartum maternal oxygen supplementation for nonreassuring fetal heart rate is associated with adverse perinatal outcomes.
A retrospective cohort study, including all individuals that underwent labor in a single tertiary medical center. On April 16, 2020, the routine use of intrapartum oxygen for category II and III fetal heart rate tracings was suspended. The study group included individuals with singleton pregnancies that underwent labor during the 7 months between April 16, 2020, and November 14, 2020. The control group included individuals that underwent labor during the 7 months before April 16, 2020. Exclusion criteria included elective cesarean section, multifetal pregnancy, fetal death, and maternal oxygen saturation <95% during delivery. The primary outcome was defined as the rate of composite neonatal outcome, consisting of arterial cord pH <7.1, mechanical ventilation, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage grade 3/4, and neonatal death. The secondary outcome was the rate of cesarean and operative delivery.
The study group included 4,932 individuals, compared with 4,906 individuals in the control group. The suspension of intrapartum oxygen treatment was associated with a significant increase in the rate of composite neonatal outcome (187 [3.8%] vs. 120 [2.4%], < 0.001), including the rate of abnormal cord arterial pH <7.1 (119 [2.4%] vs. 56 [1.1%], < 0.01). A higher rate of cesarean section due to nonreassuring fetal heart rate was noted in the study group (320 [6.5%] vs. 268 [5.5%], = 0.03).A logistic regression analysis revealed that the suspension of intrapartum oxygen treatment was independently associated with the composite neonatal outcome (adjusted odds ratio = 1.55 [95% confidence interval, 1.23-1.96]) while adjusting for suspected chorioamnionitis, intrauterine growth restriction, and recent coronavirus disease 2019 exposure.
Suspension of intrapartum oxygen treatment for nonreassuring fetal heart rate was associated with higher rates of adverse neonatal outcomes and urgent cesarean section due to fetal heart rate.
· The available data on intrapartum maternal oxygen supplementation are equivocal.. · Suspension of maternal oxygen for nonreassuring fetal heart rate during labor was associated with adverse neonatal outcomes.. · Oxygen treatment might still be important and relevant during labor..
本研究旨在评估产时因胎儿心率异常而暂停产妇吸氧是否与不良围产期结局相关。
一项回顾性队列研究，纳入在一家三级医疗中心分娩的所有产妇。2020年4月16日起，暂停对II类和III类胎儿心率监护常规使用产时吸氧。研究组包括2020年4月16日至2020年11月14日期间单胎妊娠并分娩的产妇。对照组包括2020年4月16日前7个月内分娩的产妇。排除标准包括择期剖宫产、多胎妊娠、胎儿死亡以及分娩时产妇血氧饱和度<95%。主要结局定义为复合新生儿结局发生率，包括脐动脉血pH<7.1、机械通气、呼吸窘迫综合征、坏死性小肠结肠炎、3/4级脑室内出血以及新生儿死亡。次要结局为剖宫产和手术分娩率。
研究组有4932例产妇，对照组有4906例。产时吸氧治疗的暂停与复合新生儿结局发生率显著增加相关（187例[3.8%]对120例[2.4%]，P<0.001），包括脐动脉血pH异常<7.1的发生率（119例[2.4%]对56例[1.1%]，P<0.01）。研究组因胎儿心率异常而行剖宫产的比例更高（320例[6.5%]对268例[5.5%]，P=0.03）。逻辑回归分析显示，在调整疑似绒毛膜羊膜炎、胎儿生长受限和近期2019冠状病毒病暴露因素后，产时吸氧治疗的暂停与复合新生儿结局独立相关（调整后的优势比=1.55[95%置信区间，1.23 - 1.96]）。
产时因胎儿心率异常而暂停吸氧与不良新生儿结局发生率较高以及因胎儿心率而行紧急剖宫产相关。
· 关于产时产妇吸氧的现有数据不明确。· 产时因胎儿心率异常而暂停产妇吸氧与不良新生儿结局相关。· 产时吸氧治疗可能仍然很重要且相关。
