The Effect of Normal Saline Compared to Dextrose-Saline Infusion on the Duration of Active Phase of Loabor in Nulliparous Women: A Double-Blind Randomized Controlled Clinical Trial

Document Type : Original Article

Authors

1 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Resident, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 General Physician, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Assistant Professor, Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Prolonged labor increases adverse maternal and neonatal outcomes. Very few interventions are known to shorten labor duration. The present study was performed with aim to evaluate the effect of intravenous dextrose-saline infusion compared with intravenous normal saline infusion on the duration of the active phase of labor in nulliparous women.
Methods: In this double-blind randomized clinical trial (blinding of patients and data analyst), which was performed in 2020-2021, 60 nulliparous women in the active phase of labor who had referred to the teaching hospitals of Mashhad University of Medical Sciences were randomized by block randomization method and allocated to two groups of receiving normal saline at a rate of 150cc per hour and dextrose at 5% saline at the same rate. The primary outcome was evaluating the duration of the active phase of the labor. Secondary outcomes included the duration of second phase of labor and the rate of cesarean section, maternal and neonatal outcomes. Data analysis was performed using SPSS statistical software (version 25) and Chi-square tests and Fisher's exact test. P<0.05 was considered statistically significant.
Results: The basic variables were similar in the two groups. The active phase of labor and the second stage of labor was statistically lower in saline dextrose compared to the normal saline group (P<0.001). There was no significant difference between the two groups in the rate of cesarean section, the need for oxytocin, maternal complications, first and fifth minutes Apgar score, neonatal complications and the need for NICU (P> 0.05).
Conclusion: It seems that the use of dextrose-containing solutions in nulliparous women during labor shortens the duration of labor compared to normal saline.

Keywords


  1. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dash JS, Hoffman BL, et al . Williams Obstetrics. 25nd ed . New York: McGraw-Hill; 2018.
  2. Alijahan R, Kordi M. Risk factors of dystocia in nulliparous women. Iranian Journal of Medical Sciences 2014; 39(3):254-60.
  3. World Health Organization. (‎2010)‎. Caesarean section without medical indication increases risk of short-term adverse outcomes for mothers: policy brief. World Health Organization. https://iris.who.int/handle/10665/70494
  4. Bonsack CF, Lathrop A, Blackburn M. Induction of labor: update and review. Journal of midwifery & women's health 2014; 59(6):606-15.
  5. 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. Archives of gynecology and obstetrics 2012; 286:1425-30.
  6. Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World health report 2010; 30(1):1-31.
  7. Zhu BP, Grigorescu V, Le T, Lin M, Copeland G, Barone M, et al. Labor dystocia and its association with interpregnancy interval. American journal of obstetrics and gynecology 2006; 195(1):121-8.
  8. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 107: induction of labor. Obstet Gynecol 2009; 114:386-97.
  9. Lavender T, Hart A, Smyth R. Effect of partogram use on outcomes for women in spontaneous labour at term (Cochrane Library). The Cochrane Library; 2009.
  10. 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. Archives of Gynecology and Obstetrics 2017; 295:1407-12.
  11. Fong A, Serra AE, Caballero D, Garite TJ, Shrivastava VK. 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. American Journal of Obstetrics and Gynecology 2017; 217(2):208-e1.

 

  1. Steingrímsdóttir T, Ronquist G, Ulmsten U, Waldenström A. Different energy metabolite pattern between uterine smooth muscle and striated rectus muscle in term pregnant women. European Journal of Obstetrics & Gynecology and Reproductive Biology 1995; 62(2):241-5.
  2. Shrivastava VK, Garite TJ, Jenkins SM, Saul L, Rumney P, Preslicka C, et al. A randomized, double-blinded, controlled trial comparing parenteral normal saline with and without dextrose on the course of labor in nulliparas. American journal of obstetrics and gynecology 2009; 200(4):379-e1.
  3. Kubli M, Scrutton MJ, Seed PT, O’Sullivan G. An evaluation of isotonic “sport drinks” during labor. Anesthesia & Analgesia 2002; 94(2):404-8.
  4. 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. The Journal of Maternal-Fetal & Neonatal Medicine 2020; 33(2):289-96.
  5. Pierce SJ, Kupittayanant S, Shmygol T, Wray S. The effects of pH change on Ca++ signaling and force in pregnant human myometrium. American journal of obstetrics and gynecology 2003; 188(4):1031-8.
  6. Antonakou A, Papoutsis D. The effect of epidural analgesia on the delivery outcome of induced labour: a retrospective case series. Obstetrics and gynecology international 2016; 2016.
  7. Wassen MM, Smits LJ, Scheepers HC, Marcus MA, Van Neer J, Nijhuis JG, et al. Routine labour epidural analgesia versus labour analgesia on request: a randomised non-inferiority trial. BJOG: An International Journal of Obstetrics & Gynaecology 2015; 122(3):344-50.
  8. Paré J, Pasquier JC, Lewin A, Fraser W, Bureau YA. 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. American journal of obstetrics and gynecology 2017; 216(5):508-e1.
  9. Scheepers HC, Thans MC, de Jong PA, Essed GG, Le Cessie S, Kanhai HH. A double-blind, randomised, placebo controlled study on the influence of carbohydrate solution intake during labour. BJOG: an international journal of obstetrics and gynaecology 2002; 109(2):178-81.
  10. Dapuzzo-Argiriou LM, Smulian JC, Rochon ML, Galdi L, Kissling JM, Schnatz PF, et al. A multi-center randomized trial of two different intravenous fluids during labor. The Journal of Maternal-Fetal & Neonatal Medicine 2016; 29(2):191-6.
  11. Oyaro IM. Effect of Intrapartum Normal Saline and Dextrose-saline Infusion on Course of Labour and Neonatal Outcomes Among Nulliparous Women in Kenyatta National Hospital (Doctoral dissertation).
  12. Sahhaf F, Alizadeh Ghalehlar T. Labor duration and maternal-neonatal short-term outcomes in nulliparous women with vaginal delivery receiving intravenous normal saline and intravenous dextrose. Iran J Obstet Gynecol Infertil 2019; 22(6):7-13.