Kathleen Rice Simpson1, Dotti C James. 1. Labor and Delivery, St. John's Mercy Medical Center, St. Louis; and School of Nursing, Saint Louis University, St. Louis, Missouri, USA. KRSimpson@prodigy.net
Abstract
OBJECTIVE: To evaluate the efficacy of 3 common intrauterine resuscitation techniques used during labor. METHODS:Intrauterine resuscitation techniques were prospectively evaluated in healthy women during labor. Forty-two women were randomized to either a 500-mL or 1,000-mL intravenous (IV) fluid bolus over 20 minutes. Fifty-one women were randomized to 1 of 6 position sequences including supine with the head elevated 30 degrees , left lateral and right lateral for 15 minutes each in succession. Forty-nine women received10 L/min of oxygen (O(2)) via nonrebreather face mask for 15 minutes. Differences in fetal oxygen saturation (FSpO(2)) were evaluated before, during, and after each intervention. RESULTS: An IV fluid bolus of 1,000 mL had a greater effect on FSpO(2) than an IV fluid bolus of 500 mL (500 mL: mean increase 3.7; 1,000 mL: mean increase 5.2; P = .05). Fetal oxygen saturation was higher in a lateral position (left mean 48.3%, right mean 47.7%) than in a supine position (mean supine 37.5%, P = .03). Oxygen administration increased FSpO(2) (mean increase 8.7, P = .03). The effect persisted for more than 30 minutes after the O(2) was discontinued (P = .03). For fetuses with FSpO(2) less than 40% before maternal O(2) administration, the increase was greater (mean increase 11.4) than for those with FSpO(2) of 40% or greater (mean increase 7.6, P = .03). CONCLUSION: An intravenous fluid bolus of 1,000 mL, lateral positioning, and O(2) administration at 10 L/min via nonrebreather face mask are effective in increasing FSpO(2) during labor.
RCT Entities:
OBJECTIVE: To evaluate the efficacy of 3 common intrauterine resuscitation techniques used during labor. METHODS: Intrauterine resuscitation techniques were prospectively evaluated in healthy women during labor. Forty-two women were randomized to either a 500-mL or 1,000-mL intravenous (IV) fluid bolus over 20 minutes. Fifty-one women were randomized to 1 of 6 position sequences including supine with the head elevated 30 degrees , left lateral and right lateral for 15 minutes each in succession. Forty-nine women received 10 L/min of oxygen (O(2)) via nonrebreather face mask for 15 minutes. Differences in fetal oxygen saturation (FSpO(2)) were evaluated before, during, and after each intervention. RESULTS: An IV fluid bolus of 1,000 mL had a greater effect on FSpO(2) than an IV fluid bolus of 500 mL (500 mL: mean increase 3.7; 1,000 mL: mean increase 5.2; P = .05). Fetal oxygen saturation was higher in a lateral position (left mean 48.3%, right mean 47.7%) than in a supine position (mean supine 37.5%, P = .03). Oxygen administration increased FSpO(2) (mean increase 8.7, P = .03). The effect persisted for more than 30 minutes after the O(2) was discontinued (P = .03). For fetuses with FSpO(2) less than 40% before maternal O(2) administration, the increase was greater (mean increase 11.4) than for those with FSpO(2) of 40% or greater (mean increase 7.6, P = .03). CONCLUSION: An intravenous fluid bolus of 1,000 mL, lateral positioning, and O(2) administration at 10 L/min via nonrebreather face mask are effective in increasing FSpO(2) during labor.
Authors: Robin S Cronin; Carol Chelimo; Edwin A Mitchell; Kara Okesene-Gafa; John M D Thompson; Rennae S Taylor; B Lynne Hutchison; Lesley M E McCowan Journal: BMC Pregnancy Childbirth Date: 2017-06-17 Impact factor: 3.007