Background: Fetal pulse oximetry may improve intrapartum fetal evaluation by providing a non-invasive measurement of fetal oxygen saturation (FSpo₂).

Objectives: To assess the association between abnormal intrapartum FSpo₂ and perinatal and long-term neurodevelopmental outcomes, and to evaluate if the addition of the measurement of FSpo₂ to established forms of fetal monitoring, such as fetal heart rate monitoring, affects birth, perinatal, and long-term neurodevelopmental outcomes.

Search strategy: We conducted a comprehensive search of PubMed, EMBASE, CINAHL, The Cochrane Library, Web of Science, ClinicalTrials.gov, and WHO ICTRP from database inception through February 2024, with no restrictions on date, geographic region, country income level, or language.

Selection criteria: Studies involving women in labor with a cephalic baby were included. Two interventions were reviewed: (1) low FSpo₂ (<30%), and (2) the use of fetal pulse oximetry during labor.

Data collection and analysis: Independent reviewers screened studies, extracted data, and assessed quality using the Risk of Bias tool and the Newcastle-Ottawa Scale. The approach evaluated evidence certainty. A random-effects meta-analysis followed PRISMA and MOOSE guidelines.

Main results: Forty-seven studies with 13 071 mother-infant pairs were included. FSpo₂ <30% was associated with umbilical artery pH <7.15 (odds ratio [OR] 7.86, 95% confidence interval [CI] 3.29-18.75, I² = 71%, P < 0.001), 5-min Apgar score less than 7 (OR 16.63, 95% CI 5.64-49.01, I² = 30%, P < 0.001) and NICU admission (OR 5.89, 95% CI 1.73-20.01, I² = 0%, P < 0.005). FSpo₂ monitoring combined with fetal heart rate monitoring was associated with lower odds of cesarean section for non-reassuring fetal status (OR 0.59, 95% CI 0.40-0.86, I² = 71%, P = 0.006) without impacting 5-min Apgar scores <7 (OR 0.66, 95% CI 0.37-1.17, I² = 0%, P = 0.160) or neonatal intensive care unit admissions (OR 0.98, 95% CI 0.82-1.18, I² = 0%, P = 0.840).

Conclusion: FSpo₂ monitoring combined with fetal heart rate monitoring may reduce unnecessary cesarean sections for suspected fetal distress without affecting short-term neonatal outcomes. The association between FSpo₂ <30% and adverse perinatal outcomes supports its potential as a valuable adjunct in intrapartum monitoring.

Keywords: FSpo2; blood gas monitoring; fetal heart rate monitoring; fetal monitoring; fetal oxygen saturation; intrapartum; labor; oximetry.

© 2025 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

背景：

胎儿脉搏血氧仪可能通过提供一种非侵入性的测量方法来改进产时胎儿评估，该方法可以测量胎儿血液中的氧气饱和度（FSpo₂）。

目的：

本研究旨在评估异常的产时FSpo₂与围生期和长期神经发育结局之间的关联，并且评估在现有的胎儿监护手段，如胎心率监测中加入测量FSpo₂是否会影响分娩、围生期以及长期神经发育结局。

搜索策略：

我们进行了全面的文献检索，包括PubMed、EMBASE、CINAHL、The Cochrane Library、Web of Science、ClinicalTrials.gov和WHO ICTRP数据库，从建立这些数据库开始直到2024年2月为止，没有对日期、地理区域、国家收入水平或语言进行限制。

选择标准：

纳入的研究涉及处于分娩期的妇女，并且胎儿头部朝下。审查了两种干预措施：（1）低FSpo₂值（低于30%），以及（2）在分娩过程中使用胎儿脉搏血氧仪监测。

数据收集和分析：

独立评审员筛选研究、提取数据，并使用风险偏倚工具和纽卡斯尔-渥太华量表评估质量。该方法评价证据的确定性。随后，遵循PRISMA和MOOSE指南进行了随机效应meta分析。

主要结果：

共纳入47项研究，涉及13071对母子数据。FSpo₂值低于30%与脐动脉pH值小于7.15（比值比[OR] 7.86，95%置信区间[CI] 3.29-18.75，I² = 71%，P 2 = 30%，P 2 = 0%，P 2监测结合胎心率监测与因胎儿状况不佳而进行的不必要的剖宫产几率降低（OR 0.59，95% CI 0.40-0.86，I² = 71%，P = 0.006）相关，但不影响五分钟Apgar评分低于7分的几率（OR 0.66，95% CI 0.37-1.17，I² = 0%，P = 0.160）或新生儿重症监护病房入院的几率（OR 0.98，95% CI 0.82-1.18，I² = 0%，P = 0.840）。

结论：

结合胎心率监测的FSpo₂监测可能在不改变短期新生儿结局的情况下减少不必要的怀疑胎儿窘迫剖宫产。低FSpo₂值（低于30%）与不良围生期结局之间的关联支持其作为孕期监护补充手段的价值。

关键词：

FSpo2；血液气体监测；胎心率监测；胎儿监测；胎儿血氧饱和度；分娩期间；劳动；氧合。