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Oral Concurrent Session 2 - Clinical Obstetrics and Quality

Oral Concurrent Sessions

Oral Concurrent Session 2 - Clinical Obstetrics and Quality

(25) Intrauterine Resuscitative Maneuvers for Management of Abnormal Fetal Heart Tracings: A Systematic Review and Meta-Analysis

Thursday, January 30, 2025
3:00 PM – 3:15 PM  
Location: Aurora Ballroom B, Lobby Level
Objective: To evaluate the effectiveness of 7 intrauterine resuscitative maneuvers (IRMs)—amnioinfusion, maternal oxygen supplementation, tocolysis, maternal repositioning, discontinuation of labor stimulation, and treatment of maternal hypotension or tachysystole—in mitigating adverse outcomes in the setting of non-reassuring fetal heart tracings (NRFHT).

Study Design: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) of laboring patients with NRFHT randomized to receive one of the 7 IRMs versus no intervention. The primary outcome was Apgar score < 7 at 5 minutes. Secondary outcomes included cesarean delivery rate (CD), CD for NRFHT, relief of NRFHT, umbilical artery (UA) pH < 7.10, UA pH < 7.20, and NICU admission. Summary measures were reported as relative risk (RR) with 95% confidence interval (CI) using the random effects model of DerSimonian and Laird. Higgins I2 > 0% was used to identify heterogeneity.

Results: Of 11,372 abstracts reviewed, 8 RCTs were eligible and included: 682 patients randomized to amnioinfusion vs none; 170 randomized to oxygen supplementation vs. none; and 523 randomized to tocolysis before CD vs. none. Likelihood of relief of NRFHT was significantly higher in the amnioinfusion group (68.0% vs 3.27%; RR 18.9; 95% CI 7.16, 50.26) and CD for NRFHT was significantly lower (37.8% vs 54.2%; RR 0.70; 95% CI 0.60, 0.82) vs none. Likelihood of UA pH < 7.20 was significantly lower in the tocolysis group (18.7% vs 35.4%; RR 0.40; 95% CI 0.17-0.93) vs none. The likelihood of Apgar score < 7 at 5 minutes, UA pH < 7.10, and NICU admission was similar in each group across interventions. We did not identify eligible RCTs for change in maternal position, discontinuation of labor stimulation, or treatment of maternal hypotension or tachysystole.

Conclusion: Amnioinfusion for NRFHT was found to relieve NRFHT and reduce CD. Oxygen for NRFHT did not reduce CD or improve fetal outcomes. Tocolysis for NRFHT reduced the rate of rate of fetal acidosis with UA pH < 7.20. No eligible RCTs were found for other IRMs in the setting of NRFHT.