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Kearney L, Brady S, Marsh N, Davies‐Tuck M, Nugent R, Eley V. The effects of intravenous hydration regimens in nulliparous women undergoing induction of labor: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2024; 103:1254-1262. [PMID: 38468190 PMCID: PMC11168270 DOI: 10.1111/aogs.14793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/27/2023] [Accepted: 01/07/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Labor is both a physiological and physical activity that requires energy expenditure by the woman. Despite this, women are often fasted in labor, with hydration requirements addressed predominantly by intravenous therapy. Little is known about how best to manage this in nulliparous women undergoing induction of labor, who can be prone to lengthy labors. Therefore, we undertook a systematic review and meta-analysis to determine the effects of intravenous hydration regimens on nulliparous women undergoing induction of labor. MATERIAL AND METHODS A systematic review and meta-analysis were conducted. Databases searched were PubMed, CINAHL, Embase, Cochrane, Scopus, and Web of Science using the search strategy combination of associated key concepts for intravenous therapy and nulliparous laboring women. The primary outcome was excessive neonatal weight loss. Meta-analyses for categorical outcomes included estimates of odds ratio (OR) and their 95% confidence intervals (CI) calculated; and for continuous outcomes the standardized mean difference, each with its 95% CI. Heterogeneity was assessed visually and by using the χ2 statistic and I2 with significance being set at p < 0.10. RESULTS A total of 1512 studies were located and following screening, three studies met the eligibility criteria. No studies reported excessive neonatal weight loss. Increased rates of intravenous therapy (250 mL/h vs. 125 mL/h) during labor were not found to reduce the overall length of labor (mean difference -0.07 h, 95% CI -0.27 to 0.13 h) or reduce cesarean sections (OR 0.74, 95% CI 0.45-1.23), when women were not routinely fasted. CONCLUSIONS Our review found no significant improvements for nulliparous women who received higher intravenous fluid volumes when undergoing induction of labor and were not routinely fasted. However, data are limited, and further research is needed.
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Affiliation(s)
- Lauren Kearney
- School of Nursing, Midwifery and Social WorkThe University of QueenslandSt LuciaQueenslandAustralia
- Royal Brisbane and Women's Hospital, Metro North HealthHerstonQueenslandAustralia
| | - Susannah Brady
- School of Nursing, Midwifery and Social WorkThe University of QueenslandSt LuciaQueenslandAustralia
| | - Nicole Marsh
- Royal Brisbane and Women's Hospital, Metro North HealthHerstonQueenslandAustralia
| | - Miranda Davies‐Tuck
- The Ritchie Center, Hudson Institute of Medical Research and the Department of Obstetrics and GynaecologyMonash UniversityMelbourneVictoriaAustralia
| | - Rachael Nugent
- Department of Obstetrics and GynaecologySunshine Coast Hospital and Health ServiceBirtinyaQueenslandAustralia
- Faculty of MedicineThe University of QueenslandHerstonAustralia
| | - Victoria Eley
- Royal Brisbane and Women's Hospital, Metro North HealthHerstonQueenslandAustralia
- Faculty of MedicineThe University of QueenslandHerstonAustralia
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Collinot H, Merrer J, Girault A, Goffinet F, Le Ray C. Implementation of glucose 5% supplementation protocol to reduce the duration of labor among women with cervical ripening by prostaglandins: The GLUCOSHORT before-and-after study. J Gynecol Obstet Hum Reprod 2023; 52:102558. [PMID: 36806716 DOI: 10.1016/j.jogoh.2023.102558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Previous publications have shown that glucose supplementation could reduce labor duration in women with induction of labor with a favorable cervix but none have shown it for women with an unfavorable cervix. The purpose of our study was to assess the impact on labor duration of a protocol of glucose supplementation used for induction of labor in women with an unfavorable cervix. MATERIAL AND METHODS The protocol implemented in November 2017 added glucose supplementation by 5% dextrose at 125 mL/h to Ringer lactate for women with an unfavorable cervix with labor induced with dinoprostone gel. The study included women who underwent this protocol with a singleton, term, cephalic fetus from June 2017 through April 2018. The primary outcome was the labor duration. The secondary outcomes were mode of delivery, postpartum hemorrhage rate, neonatal outcomes, and durations other stage of labor. These outcomes were compared between the pre-intervention (from June 1 to October 31, 2017) and post-intervention (from December 1, 2017 to April 30, 2018) periods. RESULTS The pre-intervention period included 116 women, and the post-intervention period 123. The characteristics of women and the induction of labor were similar in the two periods. The median duration from induction to delivery was not significantly different between the two periods (13.2 h, IQR 9.1-18.6 versus 13.6 h IQR 9.3-18.3, P=.67). The secondary outcomes did not differ significantly between the two groups. DISCUSSION Glucose supplementation administered to women with an unfavorable cervix undergoing induction does not appear to reduce the induction-delivery duration.
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Affiliation(s)
- Hélène Collinot
- Port-Royal maternity unit, Department of Obstetrics, Cochin Broca Hôtel-Dieu hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), FHU PREMA, F-75014, Paris, France; INSERM U1016, CNRS UMR8104, Institut Cochin, équipe FGTB, 24, rue du faubourg Saint-Jacques, 75014, Paris, France.
| | - Jade Merrer
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France; Clinical Research Unit of Paris Descartes Necker Cochin, APHP, Paris, France
| | - Aude Girault
- Port-Royal maternity unit, Department of Obstetrics, Cochin Broca Hôtel-Dieu hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), FHU PREMA, F-75014, Paris, France; INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
| | - François Goffinet
- Port-Royal maternity unit, Department of Obstetrics, Cochin Broca Hôtel-Dieu hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), FHU PREMA, F-75014, Paris, France; INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
| | - Camille Le Ray
- Port-Royal maternity unit, Department of Obstetrics, Cochin Broca Hôtel-Dieu hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), FHU PREMA, F-75014, Paris, France; INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
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The effect of late pregnancy date fruit consumption on delivery progress - A meta-analysis. Explore (NY) 2020; 17:569-573. [PMID: 32563673 DOI: 10.1016/j.explore.2020.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To summarize the available evidence exploring the influence of date fruit consumption on delivery outcomes. METHODS A search was conducted for relevant articles in three databases for manuscripts in English, with no time restrictions. RESULTS Four articles were eligible for inclusion. Women consuming date fruit were admitted with higher cervical dilatation (mean difference (MD) 1.1 cm [95% confidence interval (CI) 0.2-1.99 cm) and yielded a lower need for labor induction/augmentation (relative risk (RR) 0.6, 95% CI 0.43-0.83). Date fruit consumption was associated with shorter latent phase (MD -4.6 hours, 95% CI -7.77 to -1.4) and second stage duration (MD -7.7 minutes, 95% CI -12.0 to -3.4). CONCLUSIONS Although the overall quality of the included studies was weak due to high risk of bias, the results of our meta-analysis point to beneficial effects of date fruit consumption on labor process. fruit.
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Huang SY, Yu B, He X, Chen Y. Intrapartum Results on Differing Degrees of Ketonuria in Nulliparous Women with Gestational Diabetes Mellitus during Spontaneous Labor. Int J Endocrinol 2019; 2019:7207012. [PMID: 31827509 PMCID: PMC6885219 DOI: 10.1155/2019/7207012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/26/2019] [Indexed: 12/21/2022] Open
Abstract
To compare intrapartum results associated with differing degrees of ketonuria in nulliparous women with gestational diabetes mellitus (GDM), we implemented a retrospective cohort study comparing clinical characteristics among differing degrees of ketonuria and the duration and distribution of ketonuria at different stages of labor. We also analyzed adverse maternal and neonatal outcomes for each group. A total of 570 GDM deliveries were included; of these, 238 had negative ketonuria (41.8%), 180 had moderate ketonuria (31.6%), and 152 had ketosis (26.6%). The proportion of patients with a family history of diabetes significantly increased as the degree of ketonuria increased (P < 0.001). Moreover, a significantly lower level of HOMA-IR (the insulin resistance index) was observed for the Negative group (P < 0.001). The triglyceride (TG) level was significantly higher in the Ketosis group (P < 0.001), and the total cholesterol (TC) levels significantly increased as the degree of ketonuria progressed (P < 0.001). There were also higher maternal blood sugar levels and a significantly higher proportion of oxytocin augmentation in ketonuria cases (P < 0.001). Over three-fourths of patients (75.6%) had a ketonuria duration of ≤2 hours in the Moderate group, 61.2% had a ketonuria duration of between 3 and 4 h in the Ketosis group, and most of the ketonuria cases resolved in the first stage of labor. As the degree of ketonuria progressed, we observed a significantly higher number of cases with fetal heart rate pattern III (FHR pattern III), meconium-stained amniotic fluid III (MSAF III), postpartum hemorrhages, prolonged labor, neonatal hypoglycemia, an umbilical cord arterial pH of <7.2, low Apgar scores, increased neonatal intensive care admissions, augmented forceps-assisted deliveries, and conversions to cesarean sections. The results showed that ketonuria is common during the intrapartum period and that the risk of adverse maternal and neonatal outcomes may increase when complicated with ketonuria.
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Affiliation(s)
- Shi-Yun Huang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Bo Yu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Xin He
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Yi Chen
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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Abstract
Oxytocin is one of the most commonly used medications in obstetrics and has been associated with claims of negligence in cases of adverse outcomes. Errors involving intravenous oxytocin administration for induction or augmentation of labor are most commonly dose related and include failure to avoid or treat tachysystole or failure to asses or treat a fetal heart rate pattern indicative of disruption in oxygenation. Clinicians should be knowledgeable regarding pharmacokinetics of oxytocin and the effect of uterine contractions on fetal oxygenation as well as safe titration of oxytocin to achieve the desired effect while minimizing harm.
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