Interventions for Intrauterine Resuscitation in Suspected Fetal Distress During Term Labor

Importance 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. Objective 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. Evidence Acquisition 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. 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. Conclusions and Relevance 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. Target Audience Obstetricians and gynecologists, family physicians Learning Objectives 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.