Department of Obstetrics and Gynecology, MemorialCare Center for Women at Miller Children's Hospital Long Beach, Long Beach, CA.
Department of Obstetrics and Gynecology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA.
Am J Obstet Gynecol. 2017 Aug;217(2):208.e1-208.e7. doi: 10.1016/j.ajog.2017.03.010. Epub 2017 Mar 18.
Prolonged labor has been demonstrated to increase adverse maternal and neonatal outcome. A practice that may decrease the risk of prolonged labor is the modification of fluid intake during labor.
Several studies demonstrated that increased hydration in labor as well as addition of dextrose-containing fluids may be associated with a decrease in length of labor. The purpose of our study was to characterize whether high-dose intravenous fluids, standard-dose fluids with dextrose, or high-dose fluids with dextrose show a difference in the duration of labor in nulliparas.
Nulliparous subjects with singletons who presented in active labor were randomized to 1 of 3 groups of intravenous fluids: 250 mL/h of normal saline, 125 mL/h of 5% dextrose in normal saline, or 250 mL/h of 2.5% dextrose in normal saline. The primary outcome was total length of labor from initiation of intravenous fluid in vaginally delivered subjects. Secondary outcomes included cesarean delivery rate and length of second stage of labor, among other maternal and neonatal outcomes.
In all, 274 subjects who met inclusion criteria were enrolled. There were no differences in baseline characteristics among the 3 groups. There was no difference in the primary outcome of total length of labor in vaginally delivered subjects among the 3 groups. First stage of labor duration, second stage of labor duration, and cesarean delivery rates were also equivalent. There were no differences identified in other secondary outcomes including clinical chorioamnionitis, postpartum hemorrhage, blood loss, Apgar scores, or neonatal intensive care admission.
There is no difference in length of labor or delivery outcomes when comparing high-dose intravenous fluids, addition of dextrose, or use of high-dose intravenous fluids with dextrose in nulliparous women who present in active labor.
已证实产程延长会增加产妇和新生儿不良结局的风险。一种可能降低产程延长风险的做法是在分娩过程中调整液体摄入。
多项研究表明，分娩时增加水分摄入以及添加含葡萄糖的液体可能与产程缩短有关。本研究的目的是确定在初产妇中，高剂量静脉输液、含葡萄糖的标准剂量液体或高剂量含葡萄糖液体在产程持续时间上是否存在差异。
处于活跃分娩期的初产妇，按静脉输液分为 3 组：250mL/h 生理盐水、125mL/h 生理盐水加 5%葡萄糖或 250mL/h 生理盐水加 2.5%葡萄糖。主要结局为阴道分娩者静脉输液开始后的总产程时间。次要结局包括剖宫产率和第二产程时间以及其他母婴结局。
共有 274 名符合纳入标准的受试者。3 组间的基线特征无差异。在阴道分娩者中，3 组的总产程时间无差异。第一产程持续时间、第二产程持续时间和剖宫产率也相同。其他次要结局包括临床绒毛膜羊膜炎、产后出血、出血量、阿普加评分或新生儿重症监护病房入院等方面也无差异。
在活跃分娩的初产妇中，比较高剂量静脉输液、添加葡萄糖或使用高剂量含葡萄糖的静脉输液，在产程时间或分娩结局方面无差异。
