Intrauterine fetal resuscitation: from maternal repositioning to the latest pharmacological strategies

Intrauterine resuscitation includes different interventions which aim to improve fetal oxygenation when intrapartum fetal hypoxic stress leading to abnormal CTG features is suspected. Based on the etiology of the hypoxic stress, prompt institution of specific conservative measures, aiming to restore fetal oxygenation and normalize the features of the CTG trace, may reduce the incidence of unnecessary operative deliveries. However, there is paucity of evidence supporting the effectiveness of intrauterine resuscitation measures: based on available data, routine administration of fluid boluses is not recommended and should be limited only to volume-depleted patients, in which intravenous hydration has been associated with potential benefits. Similarly, amnioinfusion and maternal oxygen administration cannot be recommended as previous studies on their efficacy reported conflicting results, and some have suggested that these measures may be potentially harmful. On the other hand, changing maternal position seems to be a potentially useful maneuver with no side effects in cases of supine hypotension syndrome or in cases of suspected sustained umbilical cord compression. Administration of tocolytics for ongoing excessive uterine activity is associated with fetal heart rate improvement; within the most used tocolytic drugs, terbutaline (a beta-agonist) is often recommended as the first-choice agent to be administered for intrapartum acute tocolysis due to its efficacy, ease of administration and side effect profile.