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Recording

Oral Plenary Session I and Late-Breaking

Oral Plenary Sessions

(6) Effect of supplemental oxygen for Category II resuscitation on oxidative stress: a randomized controlled trial

Monday, February 12, 2024

5:00 PM – 5:15 PM

Location: Potomac Ballroom, Ballroom Level

Primary & Presenting Author(s)

Nandini Raghuraman, MD MSCI (she/her/hers)

Assistant Professor
Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States

Coauthor(s)

FZ

Fan Zhang, MD, MS

Washington University School of Medicine in St. Louis
St. Louis, MO, United States
BB

Brianna Bradley, BA

Washington University School of Medicine in St. Louis
St. Louis, MO, United States
Antonina I. Frolova, MD, PhD (she/her/hers)

Assistant Professor
Washington University School of Medicine in St. Louis
St. Louis, MO, United States
Ebony B. Carter, MD, MPH (she/her/hers)

Associate Professor; Director, Division of Maternal Fetal Medicine
University of North Carolina at Chapel Hill
Chapel Hill, NC, United States

Disclosure(s): I have no relevant financial relationships to report.
JK

Jeannie C. Kelly, MD, FACOG, MS

Associate Professor
Washington University School of Medicine in St. Louis, Barnes Jewish Hospital
St. Louis, MO, United States
Anthony O. Odibo, MD (he/him/his)

Professor
Washington University School of Medicine in St. Louis
St. Louis, MO, United States

Disclosure(s): I have no relevant financial relationships to report.
Molly J. Stout, MD, MSCI (she/her/hers)

University of Michigan
Ann Arbor, MI, United States

Disclosure(s): I have no relevant financial relationships to report.
DN

D Michael Nelson, MD, PhD

Washington University in St. Louis
St. Louis, MO, United States
Methodius G. Tuuli, MBA, MD, MPH

Chace-Joukowsky Professor and Chair
Women & Infants Hospital of Rhode Island, Warren Alpert Medical School of Brown University
Providence, RI, United States
Alison G. Cahill, MD

Professor
University of Texas at Austin, Dell Medical School
Austin, TX, United States

Objective: The Association of Women's Health, Obstetric and Neonatal Nurses recently recommended continued use of supplemental oxygen (O₂) for intrauterine resuscitation despite ACOG recommendations to the contrary. There is a need to address the safety of this practice given neonatal and adult literature that demonstrate a link between excess O₂ exposure and free radical-mediated oxidative cell damage. We tested the hypothesis that O₂, compared with room air (RA), for Category II fetal heart tracings (FHT) is associated with an increase in umbilical artery (UA) and maternal measures of oxidative stress.

Study Design: This was a single-center randomized controlled trial. Singleton pregnancies ³ 37 weeks with Category II FHT necessitating intrauterine resuscitation in active labor were randomized to RA or 10L/min O₂ by face mask until delivery. The primary outcomes were two UA markers of oxidative stress via free radical-mediated lipid peroxidation: malondialdehyde (MDA) and 4-hydroxynonenal (4-HNE). They were measured using commercially available thiobarbituric acid and competitive ELISA reactive substances’ assays. Secondary outcomes were maternal plasma MDA and 4-HNE at time of delivery, UA cord gases, and mode of delivery.185 patients were needed for 80% power to detect a 10% difference in UA MDA levels between groups. We increased the sample size to 212 to accommodate 15% loss to unattainable UA samples. Analysis was by intention-to-treat.

Results: Of the 212 patients randomized, 153 had UA samples that were adequate for oxidative stress analysis; 74 O₂and 79 RA. Baseline characteristics and alternate intrauterine resuscitation techniques were similar between groups. There was no difference in median UA MDA or 4-HNE between O₂and RA groups (Figure). There was no difference in maternal MDA or 4-HNE, UA gases, or mode of delivery between groups.

Conclusion: Among patients with Category II FHT in active labor, intrauterine resuscitation with supplemental O₂ is not associated with an increase in fetal or maternal lipid peroxidation markers. Clinical outcomes were similar between O₂ and RA groups.