Intrauterine resuscitation techniques during term labor are commonly used in daily clinical practice. Evidence, however, to support the beneficial effect of intrauterine resuscitation techniques on fetal distress during labor is limited and sometimes contradictory. In contrast, some of these interventions may even be harmful.
To give insight into the current evidence on intrauterine resuscitation techniques. In addition, we formulate recommendations for current clinical practice and propose directions for further research.
We systematically searched the electronic PubMed, EMBASE, and CENTRAL databases for studies on intrauterine resuscitation for suspected fetal distress during term labor until February 2015. Eligible articles and their references were independently assessed by 2 authors. Judgment was based on methodological quality and study results.
Our literature search identified 15 studies: 4 studies on amnioinfusion, 1 study on maternal hyperoxygenation, 1 study on maternal repositioning, 1 study on intravenous fluid administration, and 8 studies on tocolysis. Of these 15 research papers, 3 described a randomized controlled trial; all other studies were observational reports or case reports.
Little robust evidence to promote a specific intrauterine resuscitation technique is available. Based on our literature search, we support the use of tocolysis and maternal repositioning for fetal distress. We believe the effect of amnioinfusion and maternal hyperoxygenation should be further investigated in properly designed randomized controlled trials to make up the balance between beneficial and potential hazardous effects.
Obstetricians and gynecologists, family physicians
After completing this activity, the learner will be better able to describe the various methods that are currently used to resuscitate the distressed fetus during term labor, outline their possible mechanism of action and have insight into the effectiveness of the various resuscitation methods, and apply the method most likely to improve fetal condition during labor in case of fetal distress, based on the best available evidence.
*Resident, Department of Gynecology and Obstetrics, University Hospital Maastricht, Maastricht, and Clinical Researcher, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven; †Gynecologist-Perinatologist, Department of Gynecology and Obstetrics, Màxima Medical Center, Veldhoven, The Netherlands; ‡Clinical Researcher, Department of Gynecology and Obstetrics, Màxima Medical Center, Veldhoven, and Biomedical Engineer, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven; and §Gynecologist-Perinatologist, Department of Gynecology and Obstetrics, Màxima Medical Center, Veldhoven, and Professor, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.
Correspondence requests to: Lauren M. Bullens, MD, Gynecology and Obstetrics, University Hospital Maastricht, PO Box 7777, 6202 AZ Maastricht, The Netherlands. E-mail: email@example.com.