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BACKGROUND: Anemia is one of the most commonly diagnosed comorbidities in pregnancy and is known to increase the risk of obstetrical complications. However, little is known about the effect of anemia on placental oxygen transfer and fetal oxygenation. OBJECTIVE: This study examined the relationship between maternal anemia and fetal oxygenation status at delivery as measured by umbilical cord partial pressure of oxygen. STUDY DESIGN: This is a secondary analysis of a prospective cohort study of singleton term deliveries with universal admission complete blood count and umbilical cord gases between 2010 and 2014. Maternal anemia was defined as hemoglobin of 10 g/dL on admission. The primary outcomes were umbilical artery and vein partial pressure of oxygen; the secondary outcomes were acidemia (umbilical artery pH of <7.1), hypoxemia (umbilical artery or umbilical vein partial pressure of oxygen at the <5th percentile), and hyperoxemia (umbilical artery/umbilical vein partial pressure of oxygen at the >90th percentile). Outcomes were compared between patients with and without anemia. RESULTS: Maternal anemia was associated with a significantly higher umbilical artery partial pressure of oxygen (median [interquartile range], 20 [16e24] vs 19 [15e24] mm Hg; P¼.01) and umbilical vein partial pressure of oxygen (median [interquartile range], 30 [25e36] vs 29 [23e34] mm Hg; P<.01).Neonates born to anemic mothers were more likely to have umbilical vein hyperoxemia (15.7% vs 10.9%; adjusted odds ratio, 1.51; 95% confidence interval, 1.26e1.81) with no difference in umbilical artery hyperoxemia. There was no difference in the rates of umbilical artery or umbilical vein hypoxemia. Although maternal anemia was associated with a significant difference in umbilical artery pH (7.28AE0.060 vs 7.27AE0.065; P<.01), there was no difference in the rate of neonatal acidemia between groups (1.6% vs 1.9%; adjusted odds ratio, 0.93; 95% confidence interval, 0.55e1.55). CONCLUSION: Umbilical cord oxygen content is higher in anemic mothers. Maternal anemia may lead to adaptations in maternal, placental, and fetal physiology, allowing for easier unloading of oxygen to the placenta and increased oxygen transfer to the fetus.

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Amnioinfusion is the instillation of fluid into the uterine cavity through an intrauterine pressure catheter (IUPC) and is often used in labor to relieve variable decelerations. There is theoretical concern that amnioinfusion may increase the risk of intraamniotic infection due to washing out of the bacteriostatic properties of amniotic fluid. We sought to examine if the use of IUPC and amnioinfusion results in increased incidence of intraamniotic infection compared to IUPC placement alone. STUDY DESIGN: A retrospective cohort study was performed on women who had an IUPC placed in labor from June 2017 to June 2018 at a tertiary care center. Clinical intraamniotic infection was defined as a maternal intrapartum fever and one of more the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. Women who had a diagnosis of intraamniotic infection prior to placement of IUPC were excluded. Multivariable logistic regression was performed to compare women who had an IUPC alone to those with an IUPC and amnioinfusion after adjusting for age, race, body mass index (BMI kg/m 2), gestational age and length of rupture of membranes. The adjusted odds ratio (aOR) with 95% confidence interval (CI) were obtained. RESULTS: Of 513 women who received an IUPC in labor, 130 (25.3%) received an amnioinfusion. Demographic data between the women who did and did not receive amnioinfusion were similar, except women who received an IUPC with amnioinfusion had a lower BMI (33.4 vs. 35.3 kg/m 2 , P¼0.02). The rates of cesarean delivery, median length of time of rupture of membranes (ROM), and median length of time of IUPC placement were similar in both groups (Table 1). Compared to women with an IUPC alone, women with IUPC and amnioinfusion did not have increased odds of intraamniotic infection (5.5% vs. 5.4%; aOR 1.16 [95% CI 0.47-2.86]) or postpartum endometritis (3.4% vs 3.9%; aOR 1.13 [95% CI 0.39-3.29]). CONCLUSION: In contrast to theoretical concern, our data suggests that amnioinfusion does not increase the rate of intraamniotic infection when compared to IUPC placement alone.