Oxygen for intrauterine resuscitation: Investigating the role of oxidative stress

项目摘要/摘要 大约2/3的分娩妇女接受补充氧气(O2)，试图扭转感知到的胎儿 缺氧对胎儿电子监护(EFM)的影响。补充氧气最常用于患有以下疾病的患者 第二类EFM，一类EFM模式，部分设计用于识别胎儿酸血症。这种对氧气的自由使用 分娩病人是令人担忧的，因为婴儿的高氧血症与不良结局有关 包括视网膜病变和神经发育异常。此外，过多的氧气暴露与自由基有关。 产生和随后的氧化细胞损伤。这需要更仔细地研究宫内氧气的安全性。 曝光。拟议的项目探索了母体补充氧气的潜在危害机制 第二类流行性出血热的分娩患者。具体地说，该项目将确定氧气相对于房间的影响 空气(RA)、脐带和母体血清丙二醛(MDA)和4-羟基壬烯醛(4- HNE)，自由基氧化应激的标志物。这项研究还将探索使用尿液的可行性 氧化应激标志物作为血清标志物的一种侵入性较小的替代品，并建立时间趋势 整个分娩过程中的氧化应激。该项目将采用随机对照设计，基于最近的 完成了试点试验，证明了这种方法的可行性。这项研究的预期结果是 关于宫内氧气暴露的病理生理学的高质量、机械性、先导性数据。如果中心假说 证实分娩期间宫内暴露于氧气不如RA安全，这一发现将影响 对每年在美国分娩和分娩的数百万患者进行产中管理。最终， 这项工作将导致在分娩期间进行循证宫内复苏，将新生儿发病率降至最低。

Project Summary/Abstract Approximately 2/3 of laboring women receive supplemental oxygen (O2) in an attempt to reverse perceived fetal hypoxia on electronic fetal monitoring (EFM). O2 supplementation is most commonly used in patients with Category II EFM, a class of EFM patterns designed in part to identify fetal acidemia. This liberal use of O2 in laboring patients is concerning because hyperoxygenation in infants is associated with adverse outcomes including retinopathy and abnormal neurodevelopment. Furthermore, excess O2 exposure is linked to free radical generation and subsequent oxidative cell damage. This calls for a closer look at the safety of intrauterine O2 exposure. The proposed project explores potential mechanisms for harm with maternal O2 supplementation in laboring patients with Category II EFM. Specifically, this project will determine the effect of O2, compared to room air (RA), on umbilical cord and maternal serum levels of malondialdehyde (MDA) and 4-hydroxynonenal (4- HNE), markers of free radical-induced oxidative stress. The study will also explore the feasibility of using urine markers of oxidative stress as a less invasive alternative to serum markers and to establish temporal trends in oxidative stress throughout labor. This project will employ a randomized controlled design based on a recently completed pilot trial that demonstrated feasibility of such an approach. The expected outcome of this study is high-quality, mechanistic, pilot data on the pathophysiology of in-utero O2 exposure. If the central hypothesis that intrauterine exposure to O2 during labor is less safe than RA is confirmed, the findings will impact the intrapartum management of millions of patients who labor and deliver each year in the United States. Ultimately, this work will lead to evidence-based intrauterine resuscitation during labor that minimizes neonatal morbidity.