- Email: [email protected]
Maternal oxygen administration for intrauterine resuscitation
ajog.org
Letters to the Editors
intrapartum antibiotic treatment for GBS prophylaxis, this may result in sacrificing some precision in dispensing those medications. -
The author reports no conflict of interest.
Mark Turrentine, MD Kelsey-Seybold Clinic Department of Obstetrics & Gynecology Baylor College of Medicine Department of Obstetrics & Gynecology UT Health The University of Texas Medical School at Houston Department of Obstetrics, Gynecology, and Reproductive Sciences Houston, TX [email protected]
1. Turrentine M. Intrapartum antibiotic prophylaxis for group B Streptococcus: has the time come to wait more than 4 hours? Am J Obstet Gynecol 2014;211:15-7. 2. Turrentine M. Antenatal antibiotics: too much, too little, or just right? BJOG 2013;120:1453-5. 3. Berardi A, Rossi C, Guidotti I, et al. Factors associated with intrapartum transmission of group B Streptococcus. Pediatr Infect Dis J 2014;33:1211-5.
REFERENCES
ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog. 2014.11.002
Maternal oxygen administration for intrauterine resuscitation TO THE EDITORS: It was with great interest that we read “Oxygen for intrauterine resuscitation: of unproven benefit and potentially harmful.”1 We commend the authors for their attention to this topic. However, it should be noted that a plethora of evidence was either not cited or disregarded in order to draw the authors’ conclusions. The opinions expressed in the article stand in admittedly stark contrast to current practice and recommendations of the professional organizations American Congress of Obstetricians and Gynecologists; Association of Women’s Health, Obstetric and Neonatal Nurses; and American College of Nurse-Midwives. Administration of maternal oxygen will lead to an increase in fetal oxygen levels.2 Clearly, fetal hypoxia and acidemia have deleterious effects, thus these conditions should be avoided. Oxygen use is a scientifically supported intervention that ameliorates fetal heart rate patterns such as tachycardia and late decelerations.3 The authors’ conclusions were based on studies with small samples, including 2 nonhuman primate studies and “. 15 subjects for whom maternal oxygen had no beneficial effects on the frequency of decelerations, pH worsened significantly.” It is reasonable to conclude that recurrent patterns that are not amenable to interventions such as maternal oxygen administration may indeed be associated with a low pH or need for neonatal resuscitation. Such outcomes may be secondary to numerous historical and clinical factors, rather than a byproduct of maternal oxygen administration. A direct causative relationship between maternal oxygen administration and neonatal harm has not been definitively established. Therefore, how can one advocate for inaction in light of evidence of benefit? While oxygen administration is widely utilized for intrauterine resuscitation, current practices are changing. The authors’ concerns are valid and potential risks involved secondary to oxygen administration and subsequent free radical activity must be considered. Therefore, maternal oxygen administration may be warranted after alternative physiologic
interventions are implemented for the purpose of intrauterine resuscitation.4 Such interventions may include maternal positioning and hydration. Physiologic stressors, such as uterine activity, should be minimized. One example would be the cessation of oxytocin, a high alert uterotonic medication prior to or concurrent with maternal oxygen administration. We would like to thank the authors for their article, as it is sure to be of interest to an interdisciplinary audience of intrapartum care providers. We join with the authors in calling for further research in order to establish a clear, collaborative approach with respect to maternal oxygen administration. Jennifer L. Doyle, MSN Summa Akron City Hospital 525 E. Market St., Akron, OH 44304 [email protected] Angela C. Silber, MD Summa Akron City Hospital The authors report no conflict of interest.
REFERENCES 1. Hamel MS, Anderson BL, Rouse DJ. Oxygen for intrauterine resuscitation: of unproven benefit and potentially harmful. Am J Obstet Gynecol 2014;211:124-7. 2. Haydon ML, Gorenberg DM, Nageotte MP, et al. The effect of oxygen administration on fetal pulse oximetry during labor in fetuses with nonreassuring fetal heart rate patterns. Am J Obstet Gynecol 2006;195: 735-8. 3. Althabe O, Schwarcz RL, Pose SV, Escarcena L, Caldeyro-Barcia R. Effects on fetal heart rate and fetal PO2 of oxygen administration to the mother. Am J Obstet Gynecol 1967;98:858-70. 4. Simpson KR. Intrauterine resuscitation during labor: should maternal oxygen administration be a first-line measure? Semin Fetal Neonatal Med 2008;13:362-7. ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog. 2014.11.006
MARCH 2015 American Journal of Obstetrics & Gynecology
409
Letters to the Editors
intrapartum antibiotic treatment for GBS prophylaxis, this may result in sacrificing some precision in dispensing those medications. -
The author reports no conflict of interest.
Mark Turrentine, MD Kelsey-Seybold Clinic Department of Obstetrics & Gynecology Baylor College of Medicine Department of Obstetrics & Gynecology UT Health The University of Texas Medical School at Houston Department of Obstetrics, Gynecology, and Reproductive Sciences Houston, TX [email protected]
1. Turrentine M. Intrapartum antibiotic prophylaxis for group B Streptococcus: has the time come to wait more than 4 hours? Am J Obstet Gynecol 2014;211:15-7. 2. Turrentine M. Antenatal antibiotics: too much, too little, or just right? BJOG 2013;120:1453-5. 3. Berardi A, Rossi C, Guidotti I, et al. Factors associated with intrapartum transmission of group B Streptococcus. Pediatr Infect Dis J 2014;33:1211-5.
REFERENCES
ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog. 2014.11.002
Maternal oxygen administration for intrauterine resuscitation TO THE EDITORS: It was with great interest that we read “Oxygen for intrauterine resuscitation: of unproven benefit and potentially harmful.”1 We commend the authors for their attention to this topic. However, it should be noted that a plethora of evidence was either not cited or disregarded in order to draw the authors’ conclusions. The opinions expressed in the article stand in admittedly stark contrast to current practice and recommendations of the professional organizations American Congress of Obstetricians and Gynecologists; Association of Women’s Health, Obstetric and Neonatal Nurses; and American College of Nurse-Midwives. Administration of maternal oxygen will lead to an increase in fetal oxygen levels.2 Clearly, fetal hypoxia and acidemia have deleterious effects, thus these conditions should be avoided. Oxygen use is a scientifically supported intervention that ameliorates fetal heart rate patterns such as tachycardia and late decelerations.3 The authors’ conclusions were based on studies with small samples, including 2 nonhuman primate studies and “. 15 subjects for whom maternal oxygen had no beneficial effects on the frequency of decelerations, pH worsened significantly.” It is reasonable to conclude that recurrent patterns that are not amenable to interventions such as maternal oxygen administration may indeed be associated with a low pH or need for neonatal resuscitation. Such outcomes may be secondary to numerous historical and clinical factors, rather than a byproduct of maternal oxygen administration. A direct causative relationship between maternal oxygen administration and neonatal harm has not been definitively established. Therefore, how can one advocate for inaction in light of evidence of benefit? While oxygen administration is widely utilized for intrauterine resuscitation, current practices are changing. The authors’ concerns are valid and potential risks involved secondary to oxygen administration and subsequent free radical activity must be considered. Therefore, maternal oxygen administration may be warranted after alternative physiologic
interventions are implemented for the purpose of intrauterine resuscitation.4 Such interventions may include maternal positioning and hydration. Physiologic stressors, such as uterine activity, should be minimized. One example would be the cessation of oxytocin, a high alert uterotonic medication prior to or concurrent with maternal oxygen administration. We would like to thank the authors for their article, as it is sure to be of interest to an interdisciplinary audience of intrapartum care providers. We join with the authors in calling for further research in order to establish a clear, collaborative approach with respect to maternal oxygen administration. Jennifer L. Doyle, MSN Summa Akron City Hospital 525 E. Market St., Akron, OH 44304 [email protected] Angela C. Silber, MD Summa Akron City Hospital The authors report no conflict of interest.
REFERENCES 1. Hamel MS, Anderson BL, Rouse DJ. Oxygen for intrauterine resuscitation: of unproven benefit and potentially harmful. Am J Obstet Gynecol 2014;211:124-7. 2. Haydon ML, Gorenberg DM, Nageotte MP, et al. The effect of oxygen administration on fetal pulse oximetry during labor in fetuses with nonreassuring fetal heart rate patterns. Am J Obstet Gynecol 2006;195: 735-8. 3. Althabe O, Schwarcz RL, Pose SV, Escarcena L, Caldeyro-Barcia R. Effects on fetal heart rate and fetal PO2 of oxygen administration to the mother. Am J Obstet Gynecol 1967;98:858-70. 4. Simpson KR. Intrauterine resuscitation during labor: should maternal oxygen administration be a first-line measure? Semin Fetal Neonatal Med 2008;13:362-7. ª 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajog. 2014.11.006
MARCH 2015 American Journal of Obstetrics & Gynecology
409