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Hill MG. Maternal levels of care during pregnancy influence labor and delivery outcomes - present practices and future priorities. Semin Fetal Neonatal Med 2024:101529. [PMID: 38614837 DOI: 10.1016/j.siny.2024.101529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
Neonatal encephalopathy (NE) is a diagnosis that is usually unexpected. Though there are many risk factors for the condition and multiple theories as to its genesis, the majority of cases cannot be predicted prior to the occurrence of the clinical syndrome. Indeed, it is common for a pregnant person to have multiple risk factors and a completely healthy child. Conversely, people with seemingly no risk factors may go on to have a profoundly affected child. In this synopsis we review risk factors, potential mechanisms for encephalopathy, the complicated issue of choosing which morbidity to take on and how the maternal level of care may influence outcomes. The reader should be able to better understand the limitations of current testing and the profound levels of maternal intervention that have been undertaken to prevent or mitigate the rare, but devastating occurrence of NE. Further, we suggest candidate future approaches to prevent the occurrence, and decrease the severity of NE. Any future improvements in the NE syndrome cannot be achieved via obstetric intervention and management alone or conversely, by improvements in treatments offered post-birth. Multidisciplinary approaches that encompass prepregnancy health, pregnancy care, intrapartum management and postpartum care will be necessary.
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Affiliation(s)
- Meghan G Hill
- The Department of Obstetrics and Gynaecology, School of Medicine, The University of Auckland, New Zealand.
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Osada A, Arimitsu T, Kusakawa M, Kin T, Hida M. A case of severe neonatal transient hyperinsulinemic hypoglycaemia without identifiable risk factors: a case report. BMC Pregnancy Childbirth 2022; 22:423. [PMID: 35590270 PMCID: PMC9121614 DOI: 10.1186/s12884-022-04763-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/16/2022] [Indexed: 05/31/2023] Open
Abstract
Background Neonatal hypoglycaemia is one of the major metabolic disorders that causes irreversible brain injury. Assessing for maternal glucose metabolism disorders can predict and avoid this perinatal complication. Accordingly, diagnosing maternal gestational diabetes mellitus (GDM) is important in protecting neonatal neurological prognosis. However, there are various methods of screening for maternal GDM. The intervention for neonatal hypoglycaemia also varies within each guideline. Case presentation A female infant was born at 37 weeks of gestation by vaginal delivery with no asphyxia. Her mother had no abnormal findings, including glucose metabolism disorders, upon periodic prenatal visits. Upon routine examination at the first hour of life, the baby was lethargic, pale, hypotonic, and rarely cried. An emergent systemic evaluation was performed, and she was diagnosed with severe hyperinsulinemic hypoglycaemia with blood glucose of 11 mg/dL and insulin of 2.7 µU/mL. She was soon fed with milk and her symptoms of hypoglycaemia was resolved before receiving intravenous glucose infusion. Her blood glucose level reached 78 mg/dL 3 h after delivery. She was discharged home with her mother on day 6 of age without relapse of hypoglycaemia. Upon review, we determined that the mother was diagnosed with GDM during her previous pregnancy but not during this current pregnancy. The infant had no developmental delay upon check-up at 6 months. Conclusions The infant of this case was not a candidate for neonatal hypoglycaemia screening since her mother had no identifiable risk factors. This case suggests that previous maternal history of GDM might be the cause of neonatal hyperinsulinemic hypoglycaemia. Clinicians need to be aware of the possibility of hypoglycaemia among newborns with a maternal previous history of GDM, regardless of the mother’s current diagnosis. Immediate oral feeding can be one of the treatments, even for symptomatic neonatal severe hypoglycaemia, when rapid intravenous access is difficult. The present case also suggests the necessity of considering neonatal outcomes as well as maternal ones when screening for maternal disorders of glucose metabolism.
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Affiliation(s)
- Asami Osada
- Department of Pediatrics, Keio University School of Medicine, 35-Shinomachi, Shinjuku-ku, Tokyo, To, 160-8582, Japan
| | - Takeshi Arimitsu
- Department of Pediatrics, Keio University School of Medicine, 35-Shinomachi, Shinjuku-ku, Tokyo, To, 160-8582, Japan.
| | - Moe Kusakawa
- Department of Pediatrics, Keio University School of Medicine, 35-Shinomachi, Shinjuku-ku, Tokyo, To, 160-8582, Japan
| | - Takane Kin
- Department of Pediatrics, Keio University School of Medicine, 35-Shinomachi, Shinjuku-ku, Tokyo, To, 160-8582, Japan
| | - Mariko Hida
- Department of Pediatrics, Keio University School of Medicine, 35-Shinomachi, Shinjuku-ku, Tokyo, To, 160-8582, Japan
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Shi Y, Dong B, Dong Q, Zhao Z, Yu Y. Effect of Preoperative Oral Carbohydrate Administration on Patients Undergoing Cesarean Section with Epidural Anesthesia: A Pilot Study. J Perianesth Nurs 2020; 36:30-35. [PMID: 33239219 DOI: 10.1016/j.jopan.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of preoperative oral carbohydrate administration on patients undergoing Cesarean section with epidural anesthesia. DESIGN Randomized controlled clinical study. METHODS A total of 75 patients undergoing Cesarean section (American Society of Anesthesiologists physical status grade I-II) were randomized to preparation with a carbohydrate drink (CHO group), flavored water (placebo group), or to the fasting group. The CHO and placebo groups were double-blinded and given 300 mL of the drink 2 hours before surgery. Visual analog scores of the patient were assessed to evaluate thirst, hunger, and anxiety level, and the gastric antral cross-sectional areas were recorded by ultrasonography during the operative period. Insulin resistance was calculated on the basis of the blood glucose and insulin levels assessed before administration and after surgery. FINDINGS The CHO and placebo groups did not show an increase in gastric fluid volumes in terms of gastric antral cross-sectional area, and there were no adverse events. The visual analog scale scores at preoperative baseline were not different between groups . During the preoperative waiting period, preparation with CHO reduced not only thirst and anxiety more efficiently than water (placebo) but also hunger (P < .05), whereas water did not. No difference was observed in insulin resistance between groups before intake of the drink. Compared with the preoperative levels, insulin resistance showed a statistically significant increase in all groups (P < .05); however, the increase was significantly higher in the fasting and placebo groups than in the CHO group (P < .05). CONCLUSIONS Preoperative administration of CHO decreases postoperative insulin resistance and enhances pregnant women's comfort, leading to a reduced sense of thirst, hunger, and anxiety during the preoperative period for Cesarean section.
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Affiliation(s)
- Yuan Shi
- Department of Anesthesiology, Tianjin Institute of Anesthesiology, General Hospital of Tianjin Medical University, Tianjin, PR China
| | - Beibei Dong
- Department of Anesthesiology, Tianjin Institute of Anesthesiology, General Hospital of Tianjin Medical University, Tianjin, PR China
| | - Qingyun Dong
- Department of Emergency, Tianjin Institute of Anesthesiology, General Hospital of Tianjin Medical University, Tianjin, PR China
| | - Zhili Zhao
- Department of Anesthesiology, Tianjin Institute of Anesthesiology, General Hospital of Tianjin Medical University, Tianjin, PR China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Institute of Anesthesiology, General Hospital of Tianjin Medical University, Tianjin, PR China.
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Atashkhoei S, Abri R, Naghipour B, Hatami Marandi P, Fazeli Danesh MT. Effect of Glucose Containing Crystalloid Infusion on Maternal Hemodynamic Status After Spinal Anesthesia for Cesarean Section. Anesth Pain Med 2018; 8:e80184. [PMID: 30271752 PMCID: PMC6150926 DOI: 10.5812/aapm.80184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 12/22/2022] Open
Abstract
Background Despite preventive strategies, hypotension is the most common complication of spinal anesthesia in cesarean section. Objectives The aim of this study was to assess the effect of glucose-containing crystalloid infusion on maternal hemodynamic status after spinal anesthesia for cesarean section. Methods In this prospective, randomized, double-blind clinical trial, 80 parturients undergoing elective cesarean section with spinal anesthesia were studied. In group A (n = 40) ringer with 1% glucose solution (10 gr glucose in 1000 mL ringer) and in group B (n = 40) only ringer solution infused before and after spinal anesthesia. Demographic data, hemodynamic change, complications and their treatments, maternal blood sugar level and neonatal APGAR (appearance, pulse, grimace, activity and respiration) score, intraoperative fluid, duration of surgery, and anesthesia were recorded in the two groups. Results The incidence of hypotension in group A was significantly lower than group B (27.5% vs 75%) (P = 0.002). Other complications (sustained hypotension, nausea, pallor, and shivering were significantly lower in parturients of the group A (P < 0.05). Maternal blood sugar (BS), before and after surgery, was not significantly different in the two groups (P = 0.207 and P = 0.239, respectively). There was no statistically significant difference in the APGAR score of neonates at the 1st and 5th minutes of the birth between the two groups (P = 0.076). Conclusions It seems that adding 1% glucose to crystalloid solution improves the hemodynamic status and decreases post-spinal anesthesia complications without significant changes in the maternal blood sugar level and APGAR score of neonates.
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Affiliation(s)
- Simin Atashkhoei
- Department of Anesthesiology and Critical Care, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reyhaneh Abri
- Department of Anesthesiology and Critical Care, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Assistant professor, Department of Anesthesiology and Critical Care, Alzahra Hospital, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Tel/Fax:: +98-4135539163,
| | - Bahman Naghipour
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mohammad Taher Fazeli Danesh
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Riegel M, Quist-Nelson J, Saccone G, Locci M, Shrivastava VK, Salim R, Fisher A, Nordstrom L, Kunselman AR, Repke J, Fong A, Smulian J, Xodo S, Mokhtari N, Zullo F, Berghella V. Dextrose intravenous fluid therapy in labor reduces the length of the first stage of labor. Eur J Obstet Gynecol Reprod Biol 2018; 228:284-294. [PMID: 30055509 DOI: 10.1016/j.ejogrb.2018.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
The aim of this systematic review with meta-analysis was to evaluate the effect on length of labor when patients receive IVF with or without dextrose. Searches were performed in electronic databases from inception of each database to May 2018. Trials comparing intrapartum IVF containing dextrose (i.e. intervention group) with no dextrose or placebo (i.e. control group) were included. Only trials examining low-risk pregnancies in labor at ≥36 weeks were included. Studies were included regardless of oral intake restriction. The primary outcome was the length of total labor from randomization to delivery. The meta-analysis was performed using the random effects model. Sixteen trials (n = 2503 participants) were included in the meta-analysis. Women randomized in the IVF dextrose group did not have a statistically significant different length of total labor from randomization to delivery compared to IVF without dextrose (MD -38.33 min, 95% CI -88.23 to 11.57). IVF with dextrose decreased the length of the first stage (MD -75.81 min, 95% CI -120.67 to -30.95), but there was no change in the second stage. In summary, use of IVF with dextrose during labor in low-risk women at term does not affect total length of labor, but it does shorten the first stage of labor.
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Affiliation(s)
- Melissa Riegel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States
| | - Johanna Quist-Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vineet K Shrivastava
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA, United States
| | - Raed Salim
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Allan Fisher
- Department of Gynecology and Obstetrics, Saint Louis University School of Medicine, United States
| | - Lennart Nordstrom
- Department of Obstetrics and Gynecology, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Allen R Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - John Repke
- Penn State University College of Medicine-Milton S. Hershey Medical Center, United States
| | - Alex Fong
- Kaiser Permanente Southern California Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Irvine, CA, United States
| | - John Smulian
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Serena Xodo
- Department of Gynaecology and Obstetrics, School of Medicine, University of Udine, Udine, Italy
| | - Neggin Mokhtari
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States.
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Paré J, Pasquier JC, Lewin A, Fraser W, Bureau YA. Reduction of total labor length through the addition of parenteral dextrose solution in induction of labor in nulliparous: results of DEXTRONS prospective randomized controlled trial. Am J Obstet Gynecol 2017; 216:508.e1-508.e7. [PMID: 28153654 DOI: 10.1016/j.ajog.2017.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/21/2016] [Accepted: 01/13/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prolonged labor is a significant cause of maternal and fetal morbidity and very few interventions are known to shorten labor course. Skeletal muscle physiology suggests that glucose supplementation might improve muscle performance in case of prolonged exercise and this situation is analogous to the gravid uterus during delivery. Therefore, it seemed imperative to evaluate the impact of adding carbohydrate supplements on the course of labor. OBJECTIVE We sought to provide evidence as to whether intravenous glucose supplementation during labor induction in nulliparous women can reduce total duration of active labor. STUDY DESIGN We performed a single-center prospective double-blind randomized controlled trial comparing the use of parental intravenous dextrose 5% with normal saline to normal saline in induced nulliparous women. The study was conducted in a tertiary-level university hospital setting. Participants, caregivers, and those assessing the outcomes were blinded to group assignment. Inclusion criteria were singleton pregnancy at term with cephalic presentation and favorable cervix. Based on blocked randomization, patients were assigned to receive either 250 mL/h of intravenous dextrose 5% with normal saline or 250 mL/h of normal saline for the whole duration of induction, labor, and delivery. The primary outcome studied was the total length of active labor. Secondary outcomes included duration of the active phase of second stage of labor, the mode of delivery, Apgar scores, and arterial cord pH. RESULTS In all, 100 patients were randomized into each group. A total of 193 patients (96 in the dextrose with normal saline group and 97 in the normal saline group) were analyzed in the study. The median total duration of labor was significantly less in the dextrose with normal saline group (499 vs 423 minutes, P = .024) than in the normal saline group. The probabilities of a woman being delivered at 200 minutes and 450 minutes were 18.8% and 77.1% in the dextrose with normal saline group vs 8.2% and 59.8% in the normal saline group (Kolmogorov-Smirnov test P value = .027). There was no difference in the rate of cesarean delivery, instrumented delivery, Apgar score, or arterial cord pH. CONCLUSION Glucose supplementation significantly reduces the total length of labor without increasing the rate of complication in induced nulliparous women. Given the low cost and the safety of this intervention, glucose should be used as the default solute during labor.
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Affiliation(s)
- Josianne Paré
- Division of Obstetrics and Gynecology, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
| | - Jean-Charles Pasquier
- Division of Obstetrics and Gynecology, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Antoine Lewin
- Division of Obstetrics and Gynecology, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - William Fraser
- Division of Obstetrics and Gynecology, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Yves-André Bureau
- Division of Obstetrics and Gynecology, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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Dapuzzo-Argiriou LM, Smulian JC, Rochon ML, Galdi L, Kissling JM, Schnatz PF, Gonzalez Rios A, Airoldi J, Carrillo MA, Maines J, Kunselman AR, Repke J, Legro RS. A multi-center randomized trial of two different intravenous fluids during labor. J Matern Fetal Neonatal Med 2015; 29:191-6. [PMID: 25758624 DOI: 10.3109/14767058.2014.998190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine if the intrapartum use of a 5% glucose-containing intravenous solution decreases the chance of a cesarean delivery for women presenting in active labor. METHODS This was a multi-center, prospective, single (patient) blind, randomized study design implemented at four obstetric residency programs in Pennsylvania. Singleton, term, consenting women presenting in active spontaneous labor with a cervical dilation of <6 cm were randomized to lactated Ringer's with or without 5% glucose (LR versus D5LR) as their maintenance intravenous fluid. The primary outcome was the cesarean birth rate. Secondary outcomes included labor characteristics, as well as maternal or neonatal complications. RESULTS There were 309 women analyzed. Demographic variables and admitting cervical dilation were similar among study groups. There was no significant difference in the cesarean delivery rate for the D5LR group (23/153 or 15.0%) versus the LR arm (18/156 or 11.5%), [RR (95% CI) of 1.32 (0.75, 2.35), p = 0.34]. There were no differences in augmentation rates or intrapartum complications. CONCLUSIONS The use of intravenous fluid containing 5% dextrose does not lower the chance of cesarean delivery for women admitted in active labor.
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Affiliation(s)
- Lisa M Dapuzzo-Argiriou
- a Department of Obstetrics and Gynecology , Lehigh Valley Health Network , Allentown , PA , USA
| | - John C Smulian
- a Department of Obstetrics and Gynecology , Lehigh Valley Health Network , Allentown , PA , USA .,b University of South Florida Morsani College of Medicine , Tampa , FL , USA
| | - Meredith L Rochon
- a Department of Obstetrics and Gynecology , Lehigh Valley Health Network , Allentown , PA , USA
| | - Luisa Galdi
- c Department of Obstetrics and Gynecology , The Reading Hospital , Reading , PA , USA
| | - Jessika M Kissling
- c Department of Obstetrics and Gynecology , The Reading Hospital , Reading , PA , USA
| | - Peter F Schnatz
- c Department of Obstetrics and Gynecology , The Reading Hospital , Reading , PA , USA
| | - Angel Gonzalez Rios
- d Department of Obstetrics and Gynecology , St. Luke's University Hospital , Bethlehem , PA , USA
| | - James Airoldi
- d Department of Obstetrics and Gynecology , St. Luke's University Hospital , Bethlehem , PA , USA
| | - Mary Anne Carrillo
- e Department of Obstetrics and Gynecology , Pennsylvania State University College of Medicine , Hershey , PA , USA , and
| | - Jaimie Maines
- e Department of Obstetrics and Gynecology , Pennsylvania State University College of Medicine , Hershey , PA , USA , and
| | - Allen R Kunselman
- f Department of Public Health Sciences , Pennsylvania State University College of Medicine , Hershey , PA , USA
| | - John Repke
- e Department of Obstetrics and Gynecology , Pennsylvania State University College of Medicine , Hershey , PA , USA , and
| | - Richard S Legro
- e Department of Obstetrics and Gynecology , Pennsylvania State University College of Medicine , Hershey , PA , USA , and
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Dawood F, Dowswell T, Quenby S. Intravenous fluids for reducing the duration of labour in low risk nulliparous women. Cochrane Database Syst Rev 2013:CD007715. [PMID: 23780639 DOI: 10.1002/14651858.cd007715.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Several factors may influence the progression of normal labour. It has been postulated that the routine administration of intravenous fluids to keep women adequately hydrated during labour may reduce the period of contraction and relaxation of the uterine muscle, and may ultimately reduce the duration of the labour. It has also been suggested that intravenous fluids may reduce caesarean sections (CS) for prolonged labour. However, the routine administration of intravenous fluids to labouring women has not been adequately elucidated although it is a widely-adopted policy, and there is no consensus on the type or volume of fluids that are required, or indeed, whether intravenous fluids are at all necessary. Women may be able to adequately hydrate themselves if they were allowed oral fluids during labour.Furthermore, excessive volumes of intravenous fluids may pose risks to both the mother and her newborn and different fluids are associated with different risks. OBJECTIVES To evaluate whether the routine administration of intravenous fluids to low-risk nulliparous labouring women reduces the duration of labour and to evaluate the safety of intravenous fluids on maternal and neonatal health. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 February 2013). SELECTION CRITERIA Randomised controlled trials of intravenous fluid administration to spontaneously labouring low-risk nulliparous women. DATA COLLECTION AND ANALYSIS The review authors independently assessed trials for inclusion, trial quality and extracted data. MAIN RESULTS We included nine randomised trials with 1781 women. Three trials had more than two treatment arms and were included in more than one comparison.Two trials compared women randomised to receive up to 250 mL/hour of Ringer's lactate solution as well as oral intake versus oral intake only. For women delivering vaginally, there was a reduction in the duration of labour in the Ringer's lactate group (mean difference (MD) -28.86 minutes, 95% confidence interval (CI) -47.41 to -10.30). There was no statistical reduction in the number of CS in the Ringer's lactate group (risk ratio (RR), 0.73 95% CI 0.49 to 1.08).Three trials compared women who received 125 mL/hour versus 250 mL/hour of intravenous fluids with free oral fluids in both groups. Women receiving a greater hourly volume of intravenous fluids (250 mL) had shorter labours than those receiving 125 mL (MD 23.87 minutes, 95% CI 3.72 to 44.02, 256 women). There was no statistically significant reduction in the number of CS in the 250 mL intravenous fluid group (average RR 1.00, 95% CI 0.54 to1.87, three studies, 334 women). In one study the number of assisted vaginal deliveries was lower in the group receiving 125 mL/hour (RR 0.47, 95% CI 0.27 to 0.81).Four trials compared rates of intravenous fluids in women where oral intake was restricted (125 mL/hour versus 250 mL/hour). There was a reduction in the duration of labour in women who received the higher infusion rate (MD 105.61 minutes, 95% CI 53.19 to 158.02); P < 0.0001, however, findings must be interpreted with caution as there was high heterogeneity amongst trials (I(2) = 53%). There was a significant reduction in CS in women receiving the higher rate of intravenous fluid infusion (RR 1.56, 95% CI 1.10 to 2.21; P = 0.01). There was no difference identified in the assisted delivery rate (RR 0.78, 95% CI 0.44 to 1.40). There was no clear difference between groups in the number of babies admitted to the NICU (RR 0.48, 95% CI 0.07 to 3.17).Two trials compared normal saline versus 5% dextrose. Only one reported the mean duration of labour, and there was no strong evidence of a difference between groups (MD -12.00, 95% CI -30.09 to 6.09). A trial reporting the median suggested that the duration was reduced in the dextrose group. There was no significant difference in CS or assisted deliveries (RR 0.77, 95% CI 0.41 to 1.43, two studies, 284 women) and (RR 0.59, 95% CI 0.21 to 1.63, one study, 93 women) respectively. Only one trial reported on maternal hyponatraemia (serum sodium levels < 135 mmol/L ). For neonatal complications, there was no difference in the admission to NICU) or in low Apgar scores, however 33.3% of babies developed hyponatraemia in the dextrose group compared to 13.3 % in the normal saline group (RR 0.40, 95% CI 0.17 to 0.93) (P = 0.03). One trial reported a higher incidence of neonatal hyperbilirubinaemia in the dextrose group of babies. There was no difference in neonatal hypoglycaemic episodes between groups. AUTHORS' CONCLUSIONS Although the administration of intravenous fluids compared with oral intake alone demonstrated a reduction in the duration of labour, this finding emerged from only two trials. The findings of other trials suggest that if a policy of no oral intake is applied, then the duration of labour in nulliparous women may be shortened by the administration of intravenous fluids at a rate of 250 mL/hour rather than 125 mL/hour. However, it may be possible for women to simply increase their oral intake rather than being attached to a drip and we have to consider whether it is justifiable to persist with a policy of 'nil by mouth'. One trial raised concerns about the safety of dextrose and this needs further exploration.None of the trials reported on the evaluation of maternal views of being attached to a drip during their entire labour. Furthermore, there was no objective assessment of dehydration. The evidence from this review does not provide robust evidence to recommend routine administration of intravenous fluids. Interpreting the results from trials was hampered by the low number of trials contributing data and by variation between trials. In trials where oral fluids were not restricted there was considerable variation in the amount of oral fluid consumed by women in different arms of the same trial, and between different trials. In addition, results from trials were not consistent and risk of bias varied. Some important research questions were addressed by single trials only, and important outcomes relating to maternal and infant morbidity were frequently not reported.
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Affiliation(s)
- Feroza Dawood
- Liverpool Women’s NHS Foundation Trust, Liverpool, UK.
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Yatabe T, Tateiwa H, Ikenoue N, Kitamura S, Yamashita K, Yokoyama M. Influence of administration of 1 % glucose solution on neonatal blood glucose concentration in cesarean section. J Anesth 2012; 27:302-5. [PMID: 23132181 DOI: 10.1007/s00540-012-1512-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 10/22/2012] [Indexed: 12/20/2022]
Abstract
Perioperative administration of adequate glucose prevents hypercatabolism. However, excessive glucose administration until delivery of a fetus might cause newborn hypoglycemia in cesarean section. In this retrospective study, we investigated whether the administration of 1 % glucose solution during cesarean section influenced neonatal blood glucose concentration. We found 46 consecutive patients between 37 and 41 weeks of gestation who underwent cesarean section under combined epidural and spinal anesthesia. We divided the patients into two groups: those receiving 1 % glucose solution (group A, N = 23) and those receiving a solution without glucose (group B, N = 23) until delivery. We recorded umbilical cord blood glucose on delivery, neonatal blood glucose level 3 h after delivery, and 1- and 5-min Apgar scores. The dose of glucose administered until delivery of fetus in group A was 3.6 ± 1.7 mg/kg/min [mean ± standard deviation (SD)] and that in group B 0 mg/kg/min. Umbilical cord blood glucose concentration on delivery of fetus in group A was significantly higher than that in group B (101 ± 19 vs. 66 ± 10 mg/dl; P < 0.0001). Neonatal blood glucose level 3 h after delivery was not significantly different between groups (90 ± 15 vs. 90 ± 21 mg/dl; P = 0.96). The 1- and 5-min Apgar scores were similar between groups. In conclusion, administration of 1 % glucose solution in cesarean section might contribute to prevention of neonatal hypoglycemia.
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Affiliation(s)
- Tomoaki Yatabe
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu Oko-cho, Nankoku, Kochi 783-8505, Japan.
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Sharma C, Kalra J, Bagga R, Kumar P. A randomized controlled trial comparing parenteral normal saline with and without 5% dextrose on the course of labor in nulliparous women. Arch Gynecol Obstet 2012; 286:1425-30. [PMID: 22865033 DOI: 10.1007/s00404-012-2485-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 07/17/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of this study was to compare intravenous normal saline with and without 5% dextrose on the course of labor in nulliparous women in active phase of spontaneous labor. STUDY DESIGN In a randomized controlled trial, term, nulliparous women with singleton pregnancy in active labor were randomized into one of two groups receiving either normal saline or normal saline alternating with 5% dextrose at rate of 175 ml/h. The primary outcome was total length of labor from onset of study fluid in vaginally delivered women. Maternal and neonatal outcomes were also analyzed. RESULTS Of 250 women enrolled, in vaginally delivered subjects, there was significant difference in the duration of labor (p=0.0) and prolonged labor (p=0.01), with favorable results for women in 5% dextrose alternating with normal saline. No statistically significant differences were observed in the cesarean section rates between the groups. The cord pH was significantly higher in neonates born to women in 5% dextrose alternating with normal saline infusion as compared to normal saline alone (p=0.01), however, no neonate in the study had acidemia. CONCLUSION Administration of a 5% dextrose solution alternating with normal saline is a better parenteral fluid for significantly decreasing duration of labor in term vaginally delivered nulliparous women in spontaneous active labor as compared to normal saline alone.
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Affiliation(s)
- Chanderdeep Sharma
- DR RPGMC Kangra at Tanda, Set No. 112, Vivekanand Hostel, Kangra, Himachal Pradesh, India.
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Shrivastava VK, Garite TJ, Jenkins SM, Saul L, Rumney P, Preslicka C, Chan K. A randomized, double-blinded, controlled trial comparing parenteral normal saline with and without dextrose on the course of labor in nulliparas. Am J Obstet Gynecol 2009; 200:379.e1-6. [PMID: 19217592 DOI: 10.1016/j.ajog.2008.11.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 09/20/2008] [Accepted: 11/14/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to compare intravenous normal saline with and without dextrose on the course of labor in nulliparae. STUDY DESIGN In a double-blinded, controlled trial, term, nulliparae with singletons in active labor were randomized into 1 of 3 groups receiving either normal saline (NS), NS with 5% dextrose (D5NS), or NS with 10% dextrose (D10NS) at 125 mL/h. The primary outcome was total length of labor from onset of study fluid in vaginally delivered subjects. Maternal and neonatal outcomes were also analyzed. RESULTS Of 300 subjects enrolled, 289 met inclusion criteria and completed the study. In vaginally delivered subjects, significant differences were noted in the second stage (P = .01) and total length of labor (P = .02). No significant differences were observed in the cesarean section rates between the groups (P = .21). No differences were noted in maternal or neonatal secondary outcomes. CONCLUSION Administration of a dextrose solution, regardless of concentration, was associated with a shortened labor course in term vaginally delivered nulliparae subjects in active labor.
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Affiliation(s)
- Vineet K Shrivastava
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, Orange, CA, USA
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Moen V, Brudin L, Rundgren M, Irestedt L. Hyponatremia complicating labour--rare or unrecognised? A prospective observational study. BJOG 2009; 116:552-61. [PMID: 19175600 PMCID: PMC2675008 DOI: 10.1111/j.1471-0528.2008.02063.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective The aim of this study was to investigate the occurrence of hyponatraemia following delivery, with a hypothesis that hyponatraemia has a high prevalence in labouring women. Design Prospective observational study. Setting Consultant-led delivery suite in County Hospital, Kalmar, Sweden. Sample A total of 287 pregnant women at term (37 full gestational weeks). Methods Oral fluids were allowed during labour. Blood samples were collected on admission, after delivery, and from the umbilical artery and vein. Main outcome measure Hyponatraemia defined as plasma sodium ≤130 mmol/l after delivery. Results Hyponatraemia was found in 16 (26%) of the 61 mothers who received more than 2500 ml of fluid during labour. Two-thirds of fluids were orally ingested. Decrease in plasma sodium concentration during labour correlated with duration of labour and the total fluid volume administered. Analysis by multivariate logistic regression showed that hyponatraemia was significantly correlated with fluid volume (P < 0.001) but not with oxytocin administration or epidural analgesia. Hyponatraemia correlated significantly with prolonged second stage of labour, instrumental delivery, and emergency caesarean section for failure to progress (P = 0.002). Conclusions Hyponatraemia is not uncommon following labour. Tolerance to a water load is diminished during labour; therefore, even moderate fluid volumes may cause hyponatraemia. Women should not be encouraged to drink excessively during labour. Oral fluids, when permitted, should be recorded, and intravenous administration of hypotonic fluids should be avoided. When abundant drinking is unrecognised or intravenous fluid administration liberal, life-threatening hyponatraemia may develop. The possibility that hyponatraemia may influence uterine contractility merits further investigation.
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Affiliation(s)
- V Moen
- Department of Anaesthesiology and Intensive Care, County Hospital, Kalmar, Sweden.
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