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Original Investigation
January 4, 2021

Maternal Oxygen Supplementation Compared With Room Air for Intrauterine Resuscitation: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Department of Obstetrics and Gynecology, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 2Department of Obstetrics and Gynecology, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
  • 3Bernard Becker Medical Library, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 4Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 5Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri
  • 6Department of Women’s Health, Dell Medical School, University of Texas at Austin
  • 7Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis
JAMA Pediatr. 2021;175(4):368-376. doi:10.1001/jamapediatrics.2020.5351
Key Points

Question  Is maternal oxygen supplementation at the time of delivery associated with improved umbilical artery gas measures and neonatal outcomes?

Findings  In this systematic review and meta-analysis of 16 randomized clinical trials, peripartum maternal oxygen supplementation was associated with an improvement in umbilical artery Pao2 but no significant difference in umbilical artery pH compared with room air. Other umbilical artery gas measures, rates of neonatal intensive care unit admission, and Apgar scores were similar between the oxygen and room air groups.

Meaning  This systematic review and meta-analysis found no association between maternal oxygen supplementation and a clinically relevant improvement in umbilical artery pH or other neonatal outcomes.

Abstract

Importance  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.

Objective  To compare the association of peripartum maternal oxygen administration with room air on umbilical artery (UA) gas measures and neonatal outcomes.

Data Sources  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.

Study Selection  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 Extraction and Synthesis  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.

Main Outcomes and Measures  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.

Results  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).

Conclusions and Relevance  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.

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