Labor Clinical Trial
Official title:
A Randomized Controlled Trial Comparing Normal Saline With and Without Dextrose on the Course of Labor in Nulliparas
The purpose is to determine in term nulliparas with singletons that present in active labor (3-5 cm) or with ruptured membranes whether the administration of dextrose solutions to normal saline improves or expedites the course of labor. The researchers' hypothesis is that the addition of a carbohydrate substrate will shorten the length of labor and facilitate a vaginal delivery.
Factors that affect the course of labor have been studied extensively. Surprisingly, there
is little data on the effect that different types and rates of intravenous (IV) fluids have
during labor. Exercise physiologists have shown that increased fluid intake and carbohydrate
replacement improve skeletal muscle performance in prolonged exercise. In a 1992 randomized,
controlled study comparing IV fluid rates, Garite et al. showed a lower frequency of
prolonged labor, and possibly a decreased need for oxytocin, with higher IV fluid rates in
labor. Inadequate hydration may contribute to dysfunctional labor and possibly an increased
rate of cesarean section.
We propose that inadequate carbohydrate replacement in labor may also contribute to
prolongation of labor and increased need for operative delivery. Glucose is the main energy
supply for the pregnant uterus. Physiological requirements for glucose during labor are
approximately 10 grams per hour. Adequate supplies of glucose are needed to maintain
exercise tolerance and muscle efficiency, which are important factors in the progress of
labor. Dysfunctional labor or dystocia, which is the leading indication for primary cesarean
delivery, is caused by uterine forces insufficiently strong or inappropriately coordinated
to efface and dilate the cervix. Dystocia can also be a result of inadequate voluntary
muscle effort in the second stage of labor. It contributes to increased risk for
chorioamnionitis, which is a leading cause of maternal and fetal morbidity and mortality.
Supplying carbohydrate fuel for working uterine and skeletal muscle may improve progress in
labor and, therefore, diminish risk for chorioamnionitis and need for cesarean delivery.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Factorial Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
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