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Labor fetal anoxia — Clinical Guidelines

Overview

Fetal anoxia during labor refers to insufficient oxygen supply to the fetus, potentially leading to neonatal complications. Early detection and intervention are crucial to mitigate adverse outcomes. 1 8 11

Diagnosis

Key Diagnostic Criteria: Elevated maternal lactate levels may indicate critical illness but require cautious interpretation in obstetric patients 1.

Recommended Tests: Fetal scalp sampling for lactate measurement is beneficial over pH estimation 8.

Monitoring Techniques: Electronic fetal monitoring (EFM) is widely used but intermittent auscultation (IA) is safe and effective in low-risk pregnancies 11.

Management

First-Line Treatments: Tocolysis may be considered in preterm labor management, though clinical guidelines vary 7 9 10.

Adjunctive Treatments:

- Prostaglandin Analogs: Used for cervical ripening and induction of labor, such as PGE2 gel and double balloon devices 15. - Mechanical Methods: Cervical dilators like the cervilator can shorten active labor phases in multiparous women 16.

Fetal Support: Active management techniques aim to expedite labor but should be tailored to individual patient needs 5.

Special Populations

Pregnancy Complications: Management strategies for preterm labor vary significantly among clinicians and regions 7 9 10.

Preterm Labour: Use of antenatal corticosteroids and progesterone for women at risk of preterm birth is recommended based on clinical practice surveys 9.

Key Recommendations

Utilize Electronic Fetal Monitoring (EFM) with Caution: While widely used, consider intermittent auscultation for low-risk pregnancies to maintain normal birth processes 11 (Evidence: Moderate).

Consider Individualized Tocolysis in Preterm Labour: Despite guideline reservations, individualized use of tocolytics can be appropriate based on clinical judgment 7 9 10 (Evidence: Moderate).

Employ Cervical Ripening Techniques Based on Patient Characteristics: Use prostaglandin analogs or mechanical methods like the double balloon device for cervical ripening, considering parity and labor stage 15 16 (Evidence: Moderate).

References

1 Kern-Goldberger AR, Polin M, Bank TC, D'Alton M, Gyamfi-Bannerman C, Moroz L. Searching for a biochemical correlate of critical illness in obstetrics: a descriptive study of maternal lactate in patients presenting for acute care in pregnancy. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2022. link 2 White H, Morton VH, Stock SJ, Lavender T. Preterm labour decision-making and experiences of care for women and clinicians (QUIDS Qualitative): A qualitative exploration. Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives 2019. link 3 Allen AJ, Caughey AB. The Evolution of the Laborist. Obstetrics and gynecology clinics of North America 2017. link 4 Nitsche JF, Fino NF, Palomo JM, Perdomo AP, Brost BC. Effectiveness of a Labor Cervical Exam Model in Family Medicine and OB-GYN Residents. Family medicine 2017. link 5 Maffi I. The Detour of an Obstetric Technology: Active Management of Labor Across Cultures. Medical anthropology 2016. link 6 Neal JL, Ryan SL, Lowe NK, Schorn MN, Buxton M, Holley SL et al.. Labor Dystocia: Uses of Related Nomenclature. Journal of midwifery & women's health 2015. link 7 Diguisto C, Le Ray C, Maillard F, Khoshnood B, Verspyck E, Perrotin F et al.. Individual and organisational determinants associated with maintenance tocolysis in the management of preterm labour: a multilevel analysis. PloS one 2012. link 8 Neilson JP. Fetal scalp sampling in labour. BMJ (Clinical research ed.) 2008. link 9 Hui D, Liu G, Kavuma E, Hewson SA, McKay D, Hannah ME. Preterm labour and birth: a survey of clinical practice regarding use of tocolytics, antenatal corticosteroids, and progesterone. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2007. link32384-2) 10 Klam SL, Leduc L. Management options for preterm labour in Canada. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2004. link30362-0) 11 Albers LL. Monitoring the fetus in labor: evidence to support the methods. Journal of midwifery & women's health 2001. link00191-x) 12 March MR, Adair CD, Veille JC, Burrus DR. The modified Mueller-Hillis maneuver in predicting abnormalities in second stage labor. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 1996. link02739-7) 13 Keith RD, Westgate J, Hughes GW, Ifeachor EC, Greene KR. Preliminary evaluation of an intelligent system for the management of labour. Journal of perinatal medicine 1994. link 14 Thorp JM, Pahel-Short L, Bowes WA. The Mueller-Hillis maneuver: can it be used to predict dystocia?. Obstetrics and gynecology 1993. link 15 Atad J, Bornstein J, Calderon I, Petrikovsky BM, Sorokin Y, Abramovici H. Nonpharmaceutical ripening of the unfavorable cervix and induction of labor by a novel double balloon device. Obstetrics and gynecology 1991. link 16 Rooke PW. Mechanical dilatation of the cervix during labour. The Australian & New Zealand journal of obstetrics & gynaecology 1979. link

Labor fetal anoxia