Effects of newborn of hydration with glucose in patients undergoing caesarean section with regional anaesthesia

Peripartum metabolic control in gestational diabetes

OBJECTIVE

We sought to evaluate intrapartum metabolic control in gestational diabetes mellitus (GDM) patients and maternal factors influencing intrapartum glycemic control and neonatal hypoglycemia risk.

STUDY DESIGN

A prospective observational study included 129 women with GDM admitted for delivery. Data collected included maternal intrapartum capillary blood glucose (CBG) and ketonemia, use of insulin, and neonatal hypoglycemia.

RESULTS

In all, 86% of maternal intrapartum CBG values fell within target range (3.3-7.2 mmol/L) without need for insulin use. There were no cases of maternal hypoglycemia or severe ketosis. Intrapartum CBG >7.2 mmol/L was associated with third-trimester glycated hemoglobin (P = .02) and lack of endocrinologic follow-up (P = .04). Risk of neonatal hypoglycemia was related with pregnancy insulin use compared with dietary control (60.5% vs 29.5%; P = .02).

CONCLUSION

Peripartum metabolic control in GDM patients was achieved without insulin in most cases. Intrapartum glycemic control was related with third-trimester glycated hemoglobin and with no endocrinologic follow-up. Neonatal hypoglycemia was associated with insulin use during pregnancy.

Gestational diabetes. What are the implications?

Although gestational diabetes may have serious consequences for both mother and fetus, it is usually symptomless. The diagnosis can be missed unless all pregnant women are screened to determine those who need a full oral glucose tolerance test. When gestational diabetes is diagnosed, it is essential to (1) achieve euglycemia with diet and, if needed, insulin and (2) monitor for potential complications. Glucose tolerance must be reevaluated in the post-partum period and periodically thereafter to detect continuing intolerance or diabetes.

Recommendations for the management of low risk obstetric patients

Specific interventional procedures have enjoyed widespread popularity in the United States in the routine management of low risk obstetric patients without the benefit of clinical studies attesting to their utility. A review of the literature was conducted to survey obstetric practice with regard to amniotomy, intravenous fluids, third stage administration of oxytocics, episiotomy and continuous fetal monitoring.

Maternal and newborn levels of glucose, sodium and osmolality after preloading with three intravenous solutions during elective cesarean sections

The influence of maternal i.v. loading with 1500 ml fluid prior to epidural anesthesia and elective cesarean section was studied in 60 healthy parturients near term. Three different solutions were used. Normal saline 0.9%, Hartmann's solution and dextrose 5%. A significant rise in glucose level accompanied by a significant decrease in sodium level was found in mothers and newborns of the group hydrated with the dextrose solution.

Effects of drugs and chemicals on the fetus and newborn (2)

Physicians have become increasingly aware of the side effects of specific drugs. Obstetricians and family physicians should especially be cognizant of the implications of the administration of any drug, not only for the pregnant mother but also for the unborn child. In this second installment of our two-part article, we conclude our review of drugs, chemicals, and environmental pollutants that may affect the fetus or newborn.

Fetal and neonatal hazards of maternal hydration with 5% dextrose before caesarean section

In a prospective randomised study, 47 fasting women undergoing elective caesarean section received one of the following three glucose regimens for prevention of hypotension before administration of epidural bupivacaine to produce anaesthesia from the T4 sensory level: (i) 150 ml of 5% dextrose in water (D5W) and 1000 ml normal saline (7.5 g dextrose); (ii) 150 ml of D5W, 350 ml of 5% dextrose in normal saline (D5NS), and 650 ml of normal saline (25 g dextrose); (iii) 150 ml D5W and 1000 ml D5NS (57.5 g dextrose). The maternal blood sugar at delivery was significantly raised in patients receiving 25 and 57.5 g of dextrose. 57.5 g of dextrose also raised the mean umbilical cord venous levels of glucose to 11.7 mmol/l and of insulin to 70 +/- 7 microU/ml, while decreasing glucagon to 24 +/- 5.3 pg/ml and arterial pH to 7.19 +/- 0.015 compared with the levels with 7.5 g dextrose. The raised insulin level caused neonatal hypoglycaemia (1.8 +/- 0.22 mmol/l) and delayed release of glucagon at 2 hours of age. There was a higher incidence of neonatal jaundice in infants exposed to 57.5 g of dextrose than in those exposed to 7.5 g. The addition of large amounts of dextrose to intravenous fluids was harmful to the fetus and of no benefit to the mother. Until a safe rate of administration is established, it is recommended that dextrose infusions immediately before delivery be limited to no more than 6 g/h.

Metabolic effects of obstetric regional analgesia and of asphyxia in the newborn infant during the first two hours after birth. I. Arterial blood glucose concentrations

Effects of obstetric regional analgesia and of asphyxia on the arterial blood glucose concentrations were investigated in 83 newborn infants divided into a control group, an asphyxia group, a continuous epidural, and a paracervical + pudendal block group. Lidocaine was used in the analgesia groups. All infants except those of the asphyxia group had 1-minute Apgar scores greater than or equal to 7.1) In the asphyxiated infants high blood glucose values and strong correlations between blood glucose concentrations and different signs of asphyxia (Apgar score, base deficit and lactate) were found. 2) In infants whose mothers were given regional analgesia the results were: (a) high glucose values in 20% of the infants and an association between increased glucose concentrations in these infants and signs of fetal distress, (b) low blood glucose values (less than 1.67 mmol/l) in 27% of the infants. It is recommended that the blood glucose is checked in the newborns after obstetric regional analgesia.

The effect of intravenous therapy during labour on maternal and cord serum sodium levels

A total of 113 women in labour were studied prospectively to determine the relation between maternal and cord serum sodium levels and the effect of intravenous infusions of glucose solutions and oxytocin during labour on the mother and infant. Maternal and cord sodium levels were correlated, with no systematic difference between the two, which is consistent with passive diffusion of sodium across the placenta. Glucose infusions and oxytocin caused statistically significant depression of maternal and cord serum sodium levels, but with the quantities used this did not adversely affect the mothers or infants. It is recommended that caution should be exercised in prescribing intravenous therapy during labour and, if more than 500 ml of fluid is required, sodium should be included.