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A double-blinded randomized controlled trial on the effects of increased intravenous hydration in nulliparas undergoing induction of labor

Published:January 31, 2022DOI:https://doi.org/10.1016/j.ajog.2022.01.024

      Background

      Rates of labor induction are increasing, raising concerns related to increased healthcare utilization costs. High-dose intravenous fluid (250 cc/h) has been previously demonstrated to shorten the time to delivery in nulliparous individuals in spontaneous labor. Whether or not this relationship exists among individuals undergoing induction of labor is unknown.

      Objective

      Our study aimed to evaluate the effect of high-dose intravenous hydration on time to delivery among nulliparous individuals undergoing induction of labor.

      Study Design

      Nulliparous individuals presenting for induction of labor with a Bishop score of ≤6 (with and without rupture of membranes) were randomized to receive either 125 cc/h or 250 cc/h of normal saline. The primary outcome was length of labor (defined as time from initiation of study fluids to delivery). Both time to overall delivery and vaginal delivery were evaluated. Secondary outcomes included the lengths of each stage of labor, the percentage of individuals delivering within 24 hours, and maternal and neonatal outcomes, including cesarean delivery rate.

      Results

      A total of 180 individuals meeting inclusion criteria were enrolled and randomized. Baseline demographic characteristics were similar between groups; however, there was a higher incidence of diabetes mellitus in the group receiving 125 cc/h. Average length of labor was similar between groups (27.6 hours in 250 cc/h and 27.8 hours in 125 cc/h), as was the length of each stage of labor. Cox regression analysis did not demonstrate an effect of fluid rate on time to delivery. Neither the admission Bishop score, body mass index, nor other demographic characteristics affected time to delivery or vaginal delivery. There were no differences in maternal or neonatal outcomes, including overall cesarean delivery rate, clinically apparent iatrogenic intraamniotic infection, Apgar scores, need for neonatal phototherapy, or neonatal intensive care unit stay.

      Conclusion

      There were no observed differences in the length of labor or maternal or neonatal outcomes with the administration of an increased rate of intravenous fluids among nulliparous individuals undergoing induction of labor.

      Key words

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      References

        • Grobman W.A.
        • Rice M.M.
        • Reddy U.M.
        • et al.
        Labor induction versus expectant management in low-risk nulliparous women.
        N Engl J Med. 2018; 379: 513-523
        • Sinkey R.G.
        • Blanchard C.T.
        • Szychowski J.M.
        • et al.
        Elective induction of labor in the 39th week of gestation compared with expectant management of low-risk multiparous women.
        Obstet Gynecol. 2019; 134: 282-287
        • Hersh A.R.
        • Skeith A.E.
        • Sargent J.A.
        • Caughey A.B.
        Induction of labor at 39 weeks of gestation versus expectant management for low-risk nulliparous women: a cost-effectiveness analysis.
        Am J Obstet Gynecol. 2019; 220: 590.e1-590.e10
        • Dawood F.
        • Dowswell T.
        • Quenby S.
        Intravenous fluids for reducing the duration of labour in low risk nulliparous women.
        Cochrane Database Syst Rev. 2013; 6: CD007715
        • Ehsanipoor R.M.
        • Saccone G.
        • Seligman N.S.
        • Pierce-Williams R.A.M.
        • Ciardulli A.
        • Berghella V.
        Intravenous fluid rate for reduction of cesarean delivery rate in nulliparous women: a systematic review and meta-analysis.
        Acta Obstet Gynecol Scand. 2017; 96: 804-811
        • Riegel M.
        • Quist-Nelson J.
        • Saccone G.
        • 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: 284-294
        • American College of Sports Medicine
        Mass participation event management for the team physician: a consensus statement.
        Med Sci Sports Exerc. 2004; 36: 2004-2008
        • Maughan R.J.
        • Noakes T.D.
        Fluid replacement and exercise stress. A brief review of studies on fluid replacement and some guidelines for the athlete.
        Sports Med. 1991; 12: 16-31
        • Noakes T.D.
        Fluid replacement during exercise.
        Exerc Sport Sci Rev. 1993; 21: 297-330
        • Rodriguez N.R.
        • Di Marco N.M.
        • Langley S.
        • American Dietetic Association, Dietitians of Canada, American College of Sports Medicine
        American College of Sports Medicine position stand. Nutrition and athletic performance.
        Med Sci Sports Exerc. 2009; 41: 709-731
        • Armstrong L.E.
        • Epstein Y.
        Fluid-electrolyte balance during labor and exercise: concepts and misconceptions.
        Int J Sport Nutr. 1999; 9: 1-12
        • Fong A.
        • Serra A.E.
        • Caballero D.
        • Garite T.J.
        • Shrivastava V.K.
        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.e1-208.e7
        • Blackwell S.C.
        • Refuerzo J.
        • Chadha R.
        • Samson J.
        Duration of labor induction in nulliparous women at term: how long is long enough?.
        Am J Perinatol. 2008; 25: 205-209
        • Hilliard A.M.
        • Chauhan S.P.
        • Zhao Y.
        • Rankins N.C.
        Effect of obesity on length of labor in nulliparous women.
        Am J Perinatol. 2012; 29: 127-132
        • Macones G.A.
        • Cahill A.
        • Stamilio D.M.
        • Odibo A.O.
        The efficacy of early amniotomy in nulliparous labor induction: a randomized controlled trial.
        Am J Obstet Gynecol. 2012; 207: 403.e1-403.e5
        • Pettker C.M.
        • Pocock S.B.
        • Smok D.P.
        • Lee S.M.
        • Devine P.C.
        Transcervical Foley catheter with and without oxytocin for cervical ripening: a randomized controlled trial.
        Obstet Gynecol. 2008; 111: 1320-1326
        • 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
        • Edwards R.K.
        • Reed C.A.
        • Villano K.S.
        • Holmes J.L.
        • Tong S.
        • Davies J.K.
        Effect of hydration on spontaneous labor outcomes in nulliparous pregnant women: a multicenter randomized controlled trial comparing three methods.
        Am J Perinatol. 2014; 31: 455-462
        • 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: 1407-1412
        • Glazer K.B.
        • Danilack V.A.
        • Field A.E.
        • Werner E.F.
        • Savitz D.A.
        Term labor induction and cesarean delivery risk among obese women with and without comorbidities.
        Am J Perinatol. 2022; 39: 154-164
        • Einerson B.D.
        • Nelson R.E.
        • Sandoval G.
        • et al.
        Cost of elective labor induction compared with expectant management in nulliparous women.
        Obstet Gynecol. 2020; 136: 19-25
        • Grobman W.A.
        • Sandoval G.
        • Reddy U.M.
        • et al.
        Health resource utilization of labor induction versus expectant management.
        Am J Obstet Gynecol. 2020; 222: 369.e1-369.e11
        • Katz M.
        • Kroll D.
        • Shapiro Y.
        • Cristal N.
        • Meizner I.
        Energy expenditure in normal labor.
        Isr J Med Sci. 1990; 26: 254-257
        • Scheepers H.C.
        • de Jong P.A.
        • Essed G.G.
        • Kanhai H.H.
        Fetal and maternal energy metabolism during labor in relation to the available caloric substrate.
        J Perinat Med. 2001; 29: 457-464
        • Zhang N.
        • Zhang F.
        • Chen S.
        • et al.
        Associations between hydration state and pregnancy complications, maternal-infant outcomes: protocol of a prospective observational cohort study.
        BMC Pregnancy Childbirth. 2020; 20: 82
        • Garite T.J.
        • Simpson K.R.
        Intrauterine resuscitation during labor.
        Clin Obstet Gynecol. 2011; 54: 28-39
        • Word R.A.
        • Li X.H.
        • Hnat M.
        • Carrick K.
        Dynamics of cervical remodeling during pregnancy and parturition: mechanisms and current concepts.
        Semin Reprod Med. 2007; 25: 69-79
        • Bakker R.
        • Pierce S.
        • Myers D.
        The role of prostaglandins E1 and E2, dinoprostone, and misoprostol in cervical ripening and the induction of labor: a mechanistic approach.
        Arch Gynecol Obstet. 2017; 296: 167-179
        • Ausbeck E.B.
        • Jauk V.C.
        • Xue Y.
        • et al.
        Outpatient Foley catheter for induction of labor in nulliparous women: a randomized controlled trial.
        Obstet Gynecol. 2020; 136: 597-606
        • Main E.K.
        • Chang S.C.
        • Cheng Y.W.
        • Rosenstein M.G.
        • Lagrew D.C.
        Hospital-level variation in the frequency of cesarean delivery among nulliparous women who undergo labor induction.
        Obstet Gynecol. 2020; 136: 1179-1189
        • Timofeev J.
        • Huang C.C.
        • Singh J.
        • Driggers R.W.
        • Landy H.J.
        Spontaneous labor curves in women with pregnancies complicated by diabetes.
        J Matern Fetal Neonatal Med. 2012; 25: 20-26
        • Leftwich H.K.
        • Gao W.
        • Wilkins I.
        Does increase in birth weight change the normal labor curve?.
        Am J Perinatol. 2015; 32: 87-92
        • Blankenship S.A.
        • Woolfolk C.L.
        • Raghuraman N.
        • Stout M.J.
        • Macones G.A.
        • Cahill A.G.
        First stage of labor progression in women with large-for-gestational age infants.
        Am J Obstet Gynecol. 2019; 221: 640.e1-640.e11
        • 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
        • Coco A.
        • Derksen-Schrock A.
        • Coco K.
        • Raff T.
        • Horst M.
        • Hussar E.
        A randomized trial of increased intravenous hydration in labor when oral fluid is unrestricted.
        Fam Med. 2010; 42: 52-56
        • Ahadi Yulghunlu F.
        • Sehhatie Shafaie F.
        • Mirghafourvand M.
        • Mohaddesi H.
        The effects of intravenous dextrose 5%, Ringer’s solution, and oral intake on the duration of labor stages in nulliparous women: a double-blind, randomized, controlled trial.
        J Matern Fetal Neonatal Med. 2020; 33: 289-296