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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

Published:January 29, 2017DOI:https://doi.org/10.1016/j.ajog.2017.01.010

      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.

      Key words

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      References

        • Cheng Y.W.
        • Shaffer B.L.
        • Bryant A.S.
        • Caughey A.B.
        Length of the first stage of labor and associated perinatal outcomes in nulliparous women.
        Obstet Gynecol. 2010; 116: 1127-1135
        • Myles T.D.
        • Santolaya J.
        Maternal and neonatal outcomes in patients with a prolonged second stage of labor.
        Obstet Gynecol. 2003; 102: 52-58
        • Laughon S.K.
        • Berghella V.
        • Reddy U.M.
        • Sundaram R.
        • Lu Z.
        • Hoffman M.K.
        Neonatal and maternal outcomes with prolonged second stage of labor.
        Obstet Gynecol. 2014; 124: 57-67
        • Sheiner E.
        • Levy A.
        • Feinstein U.
        • Hallak M.
        • Mazor M.
        Risk factors and outcome of failure to progress during the first stage of labor: a population-based study.
        Acta Obstet Gynecol Scand. 2002; 81: 222-226
        • Dawood F.
        • Dowswell T.
        • Quenby S.
        Intravenous fluids for reducing the duration of labor in low risk nulliparous women.
        Cochrane Database Syst Rev. 2013; 6: CD007715
        • Murray R.
        Rehydration strategies–balancing substrate, fluid, and electrolyte provision.
        Int J Sports Med. 1998; 19: S133-S135
        • Steingrímsdóttir T.
        • Ronquist G.
        • Ulmsten U.
        • Waldenström A.
        Different energy metabolite pattern between uterine smooth muscle and striated rectus muscle in term pregnant women.
        Eur J Obstet Gynecol Reprod Biol. 1995; 62: 241-245
        • Steingrímsdóttir T.
        • Ronquist G.
        • Ulmsten U.
        Energy economy in the pregnant human uterus at term: studies on arteriovenous differences in metabolites of carbohydrate, fat and nucleotides.
        Eur J Obstet Gynecol Reprod Biol. 1993; 51: 209-215
        • Kavitha A.
        • Chacko K.P.
        • Thomas E.
        • et al.
        A randomized controlled trial to study the effect of IV hydration on the duration of labor in nulliparous women.
        Arch Gynecol Obstet. 2012; 285: 343-346
        • Garite T.J.
        • Weeks J.
        • Peters-Phair K.
        • Pattillo C.
        • Brewster W.R.
        A randomized controlled trial of the effect of increased intravenous hydration on the course of labor in nulliparous women.
        Am J Obstet Gynecol. 2000; 183: 1544-1548
        • Eslamian L.
        • Marsoosi V.
        • Pakneeyat Y.
        Increased intravenous fluid intake and the course of labor in nulliparous women.
        Int J Gynaecol Obstet. 2006; 93: 102-105
        • Scheepers H.C.J.
        • Thans M.C.J.
        • de Jong P.A.
        • Essed G.G.M.
        • Le Cessie S.
        • Kanhai H.H.H.
        A double-blind, randomized, placebo-controlled study on the influence of carbohydrate solution intake during labor.
        BJOG. 2002; 109: 178-181
        • Kubli M.
        • Scrutton M.J.
        • Seed P.T.
        • O'Sullivan G.
        An evaluation of isotonic “sport drinks” during labor.
        Anesth Analg. 2002; 94: 404-408
        • Shrivastava V.K.
        • Garite T.J.
        • Jenkins S.M.
        • et al.
        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.e1-379.e6
        • 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: 1425-1430
        • Philipson E.H.
        • Kalhan S.C.
        • Riha M.M.
        • Pimentel R.
        Effects of maternal glucose infusion on fetal acid-base status in human pregnancy.
        Am J Obstet Gynecol. 1987; 157: 866-873
        • Cerri V.
        • Tarantini M.
        • Zuliani G.
        • Schena V.
        • Redaelli C.
        • Nicolini U.
        Intravenous glucose infusion in labor does not affect maternal and fetal acid-base balance.
        J Matern Fetal Med. 2000; 9: 204-208
        • Nordström L.
        • Arulkumaran S.
        • Chua S.
        • et al.
        Continuous maternal glucose infusion during labor: effects on maternal and fetal glucose and lactate levels.
        Am J Perinatol. 1995; 12: 357-362
        • Jamal A.
        • Choobak N.
        • Tabassomi F.
        Intrapartum maternal glucose infusion and fetal acid-base status.
        Int J Gynaecol Obstet. 2007; 97: 187-189
        • Fisher A.J.
        • Huddleston J.F.
        Intrapartum maternal glucose infusion reduces umbilical cord acidemia.
        Am J Obstet Gynecol. 1997; 177: 765-769
        • Vannucci R.C.
        • Mujsce D.J.
        Effect of glucose on perinatal hypoxic-ischemic brain damage.
        Biol Neonate. 1992; 62: 215-224