Deimplementation of Routine Maternal Oxygen Supplementation for Intrauterine Fetal Resuscitation: A Retrospective...

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Perinatal Research

Background:

• Current guidelines recommend maternal oxygen for category II intrapartum tracings.
• Emerging data question the benefit of maternal oxygen supplementation for fetal resuscitation.
• This study addresses the need to validate de-implementation in clinical practice.

Purpose of the Study:

• To validate that de-implementing maternal oxygen supplementation for fetal resuscitation does not increase neonatal acidemia risk.
• To assess the real-world impact of discontinuing routine oxygen use in laboring patients with category II tracings.
• To provide evidence supporting updated clinical practice guidelines.

Main Methods:

• Retrospective observational study at a single tertiary care center (January 2019 - June 2021).
• Included singleton/twin pregnancies (23-42 weeks) with persistent category II tracings, excluding major fetal anomalies or maternal contraindications.
• Compared a historical control group with a post-deimplementation cohort, analyzing neonatal acidemia (umbilical cord pH < 7.2) and secondary outcomes.

Main Results:

• No significant difference in neonatal acidemia (13.8% vs. 15.4%) between post-deimplementation and historical control groups.
• Adjusted odds ratio for neonatal acidemia was 0.87 (95% CI: 0.62, 1.22).
• Severe acidemia, low Apgar scores, and NICU admissions were not increased post-deimplementation.

Conclusions:

• De-implementation of routine maternal oxygen supplementation for fetal resuscitation is safe and does not increase neonatal acidemia.
• Real-world data confirm experimental findings regarding maternal oxygenation during labor.
• This supports guidelines recommending against routine maternal oxygen for category II tracings.