This Practice Advisory was developed by the Committee on Clinical Practice Guidelines—Obstetrics with the assistance of Aaron Caughey, MD, PhD; Manisha Gandhi, MD; Anjali J. Kaimal, MD, MAS; and in collaboration with American College of Nurse Midwives Liaison Lisa Kane Low, PhD, CNM.
Intrauterine resuscitation in the setting of a Category II or III fetal heart tracing is addressed in Practice Bulletin No. 106, "Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles"1. In that Practice Bulletin, it is mentioned that oxygen supplementation is commonly used for intrauterine resuscitation in cases of indeterminate or abnormal fetal heart rate patterns despite inadequate data to support its use. However, an increasing body of evidence now demonstrates no benefit of intrapartum oxygen supplementation. In a recent systematic review of 16 trials involving 2,052 women, while there was an expected slight increase in umbilical artery PaO2, there was no difference in umbilical artery pH, neonatal acidemia, admission to neonatal intensive care unit, or any other meaningful clinical outcomes 2. In a recent study involving intrapartum oxygen supplementation, the results found that oxygen supplementation did not resolve category II fetal heart rate tracings 3.
Based on this body of research, routine use of oxygen supplementation in individuals with normal oxygen saturation is not recommended for fetal intrauterine resuscitation.
Please contact [email protected] with any questions.
- Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. ACOG Practice Bulletin No. 106. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;114:192-202. doi: 10.1097/AOG.0b013e3181aef106
- Raghuraman N, Temming LA, Doering MM, Stoll CR, Palanisamy A, Stout MJ, et al. Maternal oxygen supplementation compared with room air for intrauterine resuscitation: a systematic review and meta-analysis. JAMA Pediatr 2021;175:368-76. doi: 10.1001/jamapediatrics.2020.5351
- Raghuraman N, López JD, Carter EB, Stout MJ, Macones GA, Tuuli MG, et al. The effect of intrapartum oxygen supplementation on category II fetal monitoring. Am J Obstet Gynecol 2020;223:905.e1-7. doi: 10.1016/j.ajog.2020.06.037
A Practice Advisory is issued when information on an emergent clinical issue (e.g. clinical study, scientific report, draft regulation) is released that requires an immediate or rapid response, particularly if it is anticipated that it will generate a multitude of inquiries. A Practice Advisory is a brief, focused statement issued within 24-48 hours of the release of this evolving information and constitutes ACOG clinical guidance. A Practice Advisory is issued only on-line for Fellows but also may be used by patients and the media. Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines.
This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on www.acog.org or by calling the ACOG Resource Center.
While ACOG makes every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.
Publications of the American College of Obstetrician and Gynecologists are protected by copyright and all rights are reserved. The College's publications may not be reproduced in any form or by any means without written permission from the copyright owner.
The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care. www.acog.org