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36: A double-blinded randomized controlled trial comparing normal saline with and without dextrose on the course of labor in nulliparas

      Objective

      As previously seen in laboring nulliparae, increased maternal hydration has been demonstrated to shorten the frequency of prolonged labor. However, the effects of carbohydrate administration on labor duration have yet to be elucidated. The objective of this study is to compare intravenous normal saline with and without dextrose on the course of labor in nulliparae.

      Study design

      This was a double-blinded randomized controlled trial. Consenting term, nulliparae with singletons in active labor between 3-5 cm or with ruptured membranes were included. Subjects were randomized to normal saline (NS), NS with 5% dextrose (D5NS), or NS with 10% dextrose (D10NS) at 125 cc/hr. The primary outcome was total length of labor from onset of study fluid. Both maternal and neonatal outcomes were examined. A sample size of 95 patients in each group was needed for 80% power to detect shortening of total labor by 20% from 560 to 450 minutes.

      Results

      Of 300 enrolled, 290 subjects met inclusion and exclusion criteria and completed study. There were no significant differences observed in the cesarean section rates between the groups (p=0.21). In vaginally delivered subjects, significant differences were noted in time to complete dilation [(NS) 461+402 min vs. (D5NS) 363+293 min. vs. (D10NS) 340+200 min. (p=0.039)], and total length of labor [(NS) 565+408 min. vs. (D5NS) 450+302 min. vs. (D10NS) 413+202 min. (p=0.027)]. No differences were noted in oxytocin use (p=0.08), epidural administration (p=0.12) or chorioamnionitis (p=0.16). There were no differences in neonatal jaundice (p=0.12), NICU admission (p=0.16) or neonatal hypoglycemia at one (p=0.21) or two hours following delivery (p=0.38).

      Conclusion

      This study presents the novel finding that administration of a dextrose solution to nulliparae in labor compared to normal saline resulted in shorter lengths of labor in subjects who deliver vaginally. This shortening of labor with the use of dextrose solutions was accomplished without any apparent adverse neonatal outcomes.