Oxygen administration during labor

[HelenLouise]

I am a still a pretty new nurse....only three years into it now. I started fresh out of school in labor and delivery. WOULD NOT RECOMMEND THAT to you new grads! When I was orienting, an experienced nurse told me to give 15L/min of oxygen via face mask during intrauterine resucitation. So I did. And charted it. For about a year. Well, eventually I discovered that the standing order was for 10L/min. Now, I am a worried that I have SCREWED up big time and that I hyperoxygenated my patients causing harm to the fetus and their tiny fragile organs! I am petrified that I could have caused harm. Please help a young scared nurse!!! Could that extra 5L do damage in this case? How big of a "OOPS" is this in the nursing world of labor and delivery?

[lakec4me]

Actually, new research indicates that in order to raise O2 levels high enough that it will benefit the fetus, flow must be at least 12-15L, not 10. A lot of facilities have not changed their orders, but best practice based on research is that it should be 12-15.

hi klone, can you please direct me to this research? thx so much!

[klone, MSN, RN]

Actually, I can't. I made the unfortunate mistake, last spring, of taking someone else's word on it without asking for research from HER, and when I've looked myself, I can't find any research that addresses it!

So ignore what I said above! Lesson learned for me, too - never take someone else's word on research without seeing citations!

[NPinWCH]

A flow rate of 15L is fine, but the studies show that 10L increases fetal SpO2 and that the effect persists for at least 30min after it is discontinued.

http://journals.lww.com/greenjournal/Abstract/2005/06000/Efficacy_of_Intrauterine_Resuscitation_Techniques.15.aspx

[GilaRRT]

However, does increased fetal SPO2 lead to improved outcomes? What is a normal SPO2 and how do we consider fetal haemoglobin, being that it's affinity for oxygen is much different than adult haemoglobin? Also, how does this apply to the fact that new guidelines are starting to support lower FiO2 resuscitations and even room air ventilation? I'm not sure we have a clear answer?

[klone, MSN, RN]

Also, how does this apply to the fact that new guidelines are starting to support lower FiO2 resuscitations and even room air ventilation? I'm not sure we have a clear answer?

I don't know that we can compare oxygenation recommendations for the neonate and extrapolate them to oxygenation rates for the fetus, since the physiological mechanisms are different. I know one of the concerns about hyperoxygenation in the neonate is with the ductus arteriosus, which is not relevant when we're talking about the fetus.

[NPinWCH]

Depending on the study you'll see normal fetal SpO2 ranges listed from about 40% - 60% and occasionally up to 80%, with the second stage of labor resulting in lower fSpO2 levels. Most studies show that a fSpO2 level of >40% results in better outcomes for the infant and less acidosis.

Oxygen to mom increases the SpO2 more in a fetus with an SpO2 40% only had an increase of about 7.5. This would mean that there is a point where more oxygen isn't increasing fetal oxygenation.

In neonatal resuscitation, we are looking to keep SpO2 around the low to mid 90s. We don't get even close to that with intrauterine resuscitation.

http://www.ncbi.nlm.nih.gov/pubmed/11883233

http://www.researchgate.net/publication/14482953_Significance_of_fetal_arterial_oxygen_saturation_%28SpO2%29_monitoring

[JaneyW]

Thanks so much, RNINWCH, for the links to the articles. That is very helpful!