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Ovid Technologies, Inc. Email Service ------------------------------ Results: Obstetrical & Gynecological Survey (C) 2006 Lippincott Williams & Wilkins, Inc. Volume 61(10), October 2006, pp 623-625 Increased Intravenous Fluid Intake and the Course of Labor in Nulliparous Women [Obstetrics: Management of Labor, Delivery, and the Puerperium] Eslamian, L; Marsoosi, V; Pakneeyat, Y Obstetrics Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Int J Gynecol Obstet 2006;93:102-105 ---------------------------------------------- Outline ABSTRACT EDITORIAL COMMENT ABSTRACT Adequate hydration improves muscle performance during prolonged exercise, and this should apply to myometrial contractility during labor. In general, parturients receive intravenous fluid at a rate of 125 mL/hour, amounting to 3 L in 24 hours, but this rate is based on a resting patient not taking oral fluids and it does not always prevent clinical dehydration. This prospective, randomized, double-blind study compared the conventional regimen of 125 mL/hour (group 1) with 250 mL/hour of Ringer solution (group 2). Participants were 300 nulliparous women at term who had singleton pregnancies of 37 weeks or longer with a cephalic presentation. Labor began spontaneously in all cases. The 2 groups were matched for maternal and gestational ages, Bishop score, state of the membranes, birth weight, and infant gender. Women in group 1 received a mean of 810 mL of fluid, and women in group 2 1065 mL, a significant difference (P Delivering twice as much intravenous fluid during labor as is ordinarily administered significantly shortened labor in this study of nulliparous women who spontaneously entered labor at term. This practice may lessen the risk of prolonged labor and also the need for oxytocin. ---------------------------------------------- EDITORIAL COMMENT (The abstracted report of Eslamian et al is the second randomized trial to address the issue of whether a higher rate of intravenous fluid administration shortens spontaneous labor. The first was by performed by Garite et al (Am J Obstet Gynecol 2000;183:1544). Because they are the only 2, it is worthwhile to compare and contrast them. Both used virtually identical methodologies, studying healthy nulliparous women at or near term, in spontaneous early labor with a singleton vertex fetus. In both studies, randomization was to isotonic intravenous fluid (lactated Ringer or saline) at a rate of either 250 mL/hour or 125 mL/hour. In the Garite study, women used epidural anesthesia, but in the Eslamian study they did not. In the Garite trial, the total duration of labor (from admission until delivery) was shorter by approximately 1 hour in the 250 mL/hour group (484 vs 552 minutes), a difference that was not statistically significant. Fewer women in the 250 mL/hour group underwent labor augmentation (49% vs 65%), and fewer underwent cesarean delivery (10% vs 17%), but these differences were not statistically significantly different either. Women in the 250 mL/hour group received a mean volume of intravenous fluid of 2487 mL versus 2008 mL in the 125 mL/hour group or, on average, 308 mL and 218 mL, respectively, for each hour of labor. The fluid in excess of that mandated by the protocol derived from prehydration for epidural placement and discretionary nursing administration in response to concerning fetal heart rate features. In the Eslamian trial, labor was shorter by approximately 2 hours in the 250 mL/hour group (253 vs 386 minutes), and this difference was statistically significant. Overall, labors in the Eslamian trial were 3 to 4 hours shorter than in the Garite trial, and women received smaller volumes of fluid, a mean of 1065 mL in the 250 mL/hour group and 810 mL in the 125 mL/hour group or, on average, 252 mL versus 126 mL, respectively, for each hour of labor. Fewer women in the 250 mL/hour group underwent labor augmentation (8% vs 20%), and fewer underwent cesarean (16% vs 23%), but only the former difference was statistically significant, and that there would be a difference was not a formal prespecified hypothesis. There were no differences in neonatal outcomes between the offspring of women in the 250 mL/hour group and the offspring of those in the 125 mL/hour group in either trial, nor did maternal outcomes differ between groups. Specifically, pulmonary edema was not reported to have occurred. It is biologically plausible that adequate hydration would improve uterine muscle performance, as it does in long-distance runners (Maughan RJ, Noakes TD. Sports Med 1991;12:16), although the type of muscle (smooth vs striated) and nature of work (intermittent vs frequently repetitive) obviously differs between labor and running. Moreover, in neither study was the hydration status of the participants assessed, and neither study was blind or masked, which, even if laborious, could have been accomplished and would have strengthened the studies' methodologies and our confidence in the results. On most labor units, 125 mL/hour is the standard rate of intravenous fluid infusion. However, both individually and collectively, the Garite and the Eslamian studies suggest that a higher rate of intravenous fluid administration to women in labor (specifically, 250 mL/hour vs 125 mL/hour) has beneficial effects on the course and outcome of labor. We need additional rigorous study of this issue, including evaluation of fluid constituents, eg, the effects of dextrose. In the meantime, if asked how much fluid should a healthy woman in spontaneous labor receive, I will say that the available data suggest 250 mL/hour.-DJR)Accession Number: 00006254-200610000-00005 -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
