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Obstetrics & Gynecology 2005;105:1362-1368
© 2005 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Efficacy of Intrauterine Resuscitation Techniques in Improving Fetal Oxygen Status During Labor

Kathleen Rice Simpson, PhD, RNC* and Dotti C. James, PhD, RNC{dagger}

From *Labor and Delivery, St. John's Mercy Medical Center, St. Louis; and {dagger}School of Nursing, Saint Louis University, St. Louis, Missouri.

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°, left lateral and right lateral for 15 minutes each in succession. Forty-nine women received 10 L/min of oxygen (O2) via nonrebreather face mask for 15 minutes. Differences in fetal oxygen saturation (FSpO2) were evaluated before, during, and after each intervention.

RESULTS: An IV fluid bolus of 1,000 mL had a greater effect on FSpO2 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 FSpO2 (mean increase 8.7, P = .03). The effect persisted for more than 30 minutes after the O2 was discontinued (P = .03). For fetuses with FSpO2 less than 40% before maternal O2 administration, the increase was greater (mean increase 11.4) than for those with FSpO2 of 40% or greater (mean increase 7.6, P = .03).

CONCLUSION: An intravenous fluid bolus of 1,000 mL, lateral positioning, and O2 administration at 10 L/min via nonrebreather face mask are effective in increasing FSpO2 during labor.

LEVEL OF EVIDENCE: II-2






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