A multi-center randomized trial of two different intravenous fluids during labor

Lisa M Dapuzzo-Argiriou,John C Smulian,Meredith L Rochon,Luisa Galdi,Jessika M Kissling,Peter F Schnatz,Angel Gonzalez Rios,James Airoldi,Mary Anne Carrillo,Jaimie Maines,Allen R Kunselman,John Repke,Richard S Legro

doi:10.3109/14767058.2014.998190

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.

Highlights

Factors that influence the ability of women to have a successful vaginal delivery have been studied extensively
There was no significant difference in the cesarean delivery rate for the D5LR group (23/153 or 15.0%) versus the lactated Ringer (LR) arm (18/156 or 11.5%), [Risk ratios (RR) (95%CI) of 1.32 (0.75, 2.35), P=0.34]
DAPUZZO-ARGIRIOU et al Conclusions—The use of intravenous fluid containing 5% dextrose does not lower the chance of cesarean delivery for women admitted in active labor

Summary

Introduction

Factors that influence the ability of women to have a successful vaginal delivery have been studied extensively. There are data generated through studies using intrauterine pressure catheter monitoring of labor that demonstrate the importance of effective myometrial contractility for the adequate progress of labor.[2] Exercise physiologists have shown that increased fluid intake and carbohydrate replacement improve skeletal muscle performance in prolonged exercise.[3,4]. Physiological requirements for glucose during labor in a 60kg woman are estimated to be around 10 grams per hour.[5] We propose that even in the presence of adequate hydration, inadequate carbohydrate replacement in labor may contribute to prolongation of labor and an increased need for operative delivery. There are 2 studies suggesting a shorter duration of labor in nulliparous women when glucose was added to the intrapartum IV fluids, neither study demonstrated a reduction in the cesarean delivery rate.[6,7]

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Results

Conclusion