Efficacy of Intravenous Dextrose-containing Fluid in Reducing Labor Duration of Pregnant Women: A randomized controlled trial
Main Article Content
Abstract
Objectives: To evaluate the efficacy of dextrose-containing intravenous fluid and normal saline intravenous fluid in reducing labor duration in pregnant women.
Materials and Methods: In this randomized controlled trial, 164 low-risk term singleton pregnant women with gestational age of 37-42 weeks presenting with labor pain at Sanpasitthiprasong Hospital were equally randomized to receive either 1) dextrose-containing intravenous fluid (5%D/N/2) or 2) (NSS) at a rate of 120 ml/hr. Primary outcome was total labor time, defined as duration during active phase plus second stage. Duration of latent phase, active phase, first stage and second stage of labor and maternal and neonatal outcomes were also assessed
Results: Demographics, gestational age, cervical dilatation at the time of randomization and augmentation were comparable between the two groups. Total labor time was significantly shorter in dextrose group than NSS group (median 177.0, interquartile range 110.0, 258.0) and 206.5 (138.5, 298.3), p = 0.033). Active phase duration was significantly shorter in dextrose group (median 160.0 (100.0, 240.0) and 187.5 (127.3, 281.3), p = 0.029). There was no difference in latent phase, second stage, and third stage duration. Rates of cesarean delivery and maternal complications were comparable between the two groups. Transient tachypnea of the newborn was significantly higher in NSS group than dextrose group (29.3% and 9.8%, p = 0.002). There was no between-group difference in neonatal outcomes including birthweight, Apgar scores, and neonatal hypoglycemia.
Conclusion: Dextrose-containing intravenous fluid administered during intrapartum may shorten total labor time especially active phase duration, without increasing maternal and neonatal complications.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Cunningham FG, Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey BM. Williams Obstetrics. 26th ed. New York: McGraw-Hill 2022:417-32.
American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Safe prevention of the primary cesarean delivery. Obstetrics care consensus No.1. Obstet Gynecol 2014;123:693-711.
Cheng YW, Shaffer BL, Bryant AS, Caughey AB. Length of the first stage of labor and associated perinatal outcomes in nulliparous women. Obstet Gynecol 2010;116:1127–35.
Laughon SK, Berghella V, Reddy UM, Sundaram R, Lu Z, Hoffman MK. Neonatal and maternal outcomes with prolonged second stage of labor. Obstet Gynecol 2014;124:57–67.
Rizzo A, Angioni S, Spedicato M, Minoia G, Mutinati M, Trisolini C, et al. Uterine contractility is strongly influenced by steroids and glucose metabolism: an in vitro study on bovine myometrium. Gynecol Endocrinol 2011;27:636-40.
Dawood F, Dowswell T, Quenby S. Intravenous fluids for reducing the duration of labour in low-risk nulliparous women. Cochrane Database Syst Rev 2013;18:CD007715.
Singata, M, Tranmer, J, Gyte G. Restricting oral fluid and food intake during labour. Cochrane Database Syst Rev 2013; 22:CD003930.
American College of Obstetricians and Gynecologists. Approaches to limit intervention in labor and birth. Obstet Gynecol 2019;133,e164–e173.
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.
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.
Movahed F, Pakniat H, Ataee M, Barikani A, Jamsi L. Normal saline and dextrose saline infusion comparison in the duration of active phase in nulliparous women. Biotech Health Sci 2015;2:e31666.
Dapuzzo-Argiriou LM, Smulian JC, Rochon ML, Galdi L, Kissling JM, Schnatz PF, et al. A multi-center randomized trial of two different intravenous fluids during labor. J Matern Fetal Neonatal Med 2016;29: 191-6.
Swidan KH, Abou-gamrah AA, AbdelShafy A, Abughanima MO. Effect of normal saline infusion versus dextrose 5% infusion on the duration of labor in nulliparous women: Randomized controlled trial. EJHM 2017;68:1452-61.
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.e1-7.
Fong A, Serra AE, Caballero D, Garite TJ, Shrivastava VK. A randomized, double-blinded, controlled trial of the effects of fluid rate and/or presence of dextrose in intravenous fluids on the labor course of nulliparas. Am J Obstet Gynecol 2017;217:208.e1-7.
Shafaie FS, Mohaddesi M, Mirghafourvand M, Yulghunlu FA. A randomized double-blinded, controlled trial comparing parenteral dextrose 5%, ringer’s solution and oral intake on the delivery outcomes in nulliparas. IJWHR 2017;5:283-89.
Garmi G, Zuarez-Easton S, Zafran N, Ohel I, Berkovich I, Salim R. The effect of type and volume of fluid hydration on labor duration of nulliparous women: a randomized controlled trial. Arch Gynecol Obstet 2017;295:1407-12.
Ehsanipoor RM, Saccone G, Seligman NS, Pierce-Williams RAM, Ciardulli A, Berghella V. Intravenous fluid rate for reduction of cesarean delivery rate in nulliparous women: A systematic review and meta-analysis. AOGS 2017;96:804-11.
Riegel M, Quist-Nelson J, Saccone G, Locci M, Shrivastava VK, Salim R, Fisher A, et al. Dextrose intravenous fluid therapy in labor reduces the length of the first stage of labor. Eur J Obstet Gynecol Reprod Biol 2018;228:284-94.
Yulghunlu FA, Shafaie FS, Mirghafourvand M, Mohaddesi M. The effects of intravenous dextrose 5%, ringer’solution and oral intake on the duration of labor stages in nulliparous women: A double-blinded randomized controlled trial. J Matern Fetal Neonatal Med 2020;33:289-96.
World Health Organization. Education material for teachers of midwifery managing prolonged and obstructed labor. 2nd ed. France: WHO Press; 2008.
Yurdakok M. Transient tachypnea of the newborn: what is new? J Matern Fetal Neonatal Med 2010;23: 24-6.
Leimert KB, Xu W, Princ MM, Chemtob S, Olson DM. Inflammatory amplification: A central tenet of uterine transition for labor. Front Cell Infect Microbiol 2021; 11:1-19.
Dagenais A, Fre´chette R, Yamagata Y, Yamagata T, Carmel JF, Clermont ME, et al. Downregulation of ENaC activity and expression by TNF-a in alveolar epithelial cells. Am J Physiol Lung Cell Mol Physiol 2003;286:301-11.
Imran M, Kamran A, Al-dardery NM, Farooq DA, El-Samahy M, Ali Farho M. Intravenous Ringer’s lactate versus usual care during labor in nulliparous women: a systematic review and meta-analysis of randomized controlled trials. Curr Med Res Opin 2023;40:141–9.
Edwards RK, Reed CA, Villano KS, Holmes JL, Tong S, Davies JK. Effect of hydration on spontaneous labor outcomes in nulliparous pregnant women: a multicenter randomized controlled trial comparing three methods. Am J Perinatol 2014; 31: 455-62.
Kamkong J, Pongsamakthai M, Sripipatanakul M, Tangsiriwatthana T. The effect of hyoscine butylbromide for shortening the active phase of the first stage of labor: A randomized, double-blind, placebo-controlled trial. Thai J Obstet Gynaecol 2024; 32: 245-53.