AT THE PREGNANCY MEETING
LAS VEGAS (FRONTLINE MEDICAL NEWS) – Adding 5% dextrose to the hydrating solution given to women undergoing induced labor safely led to a median 76-minute decrease in labor duration in a single-center randomized study.
Normal saline with 5% dextrose “should be considered the default solute during labor induction in nulliparous women,” Josianne Paré, MD, said at the annual Pregnancy Meeting sponsored by the Society for Maternal-Fetal Medicine. “The uterus is a muscle, and glucose is its main energy substrate.”
The researchers randomized nulliparous women carrying monofetal pregnancies to term in the DEXTRONS (Use of Normal Saline With or Without Dextrose During Induction of Labor in Nulliparous) trial. They excluded women with diabetes, heart disease, or preeclampsia. Participants also needed to have a favorable cervix to be included in the study.
During January 2013 to January 2015, women who met these criteria and required induction received either normal saline or normal saline plus 5% dextrose when they began their oxytocin drip, at a rate of 250 mL/hour.
Treatment with the assigned hydrating solutions continued until delivery or C-section. Participants averaged 28 years old, their average body mass index was 26 kg/m2 and average birth weight was about 3,450 g.
The study’s primary outcome was total duration of labor. This was a median of 423 minutes in 96 women who received dextrose and were available for analysis, and a median of 499 minutes in 97 evaluable women who received the saline control, a median difference of 76 minutes that was statistically significant, Dr. Paré reported. Most of the difference in labor duration happened during the first stage, which showed a median 70-minute reduction between the control group and the women receiving dextrose.
The dextrose supplement also appeared safe for the mothers and neonates, with no apparent impact on mode of delivery, APGAR scores, or cord pH. The investigators did not monitor neonatal hypoglycemia systematically, but glycemia was checked in 53 neonates, and none were hypoglycemic, said Dr. Paré, a researcher at the University of Sherbrooke (Que.).
“These results support findings from prior studies. Women need glucose during labor,” Elliott Main, MD, commented in an interview. “There is no evidence for a need to exclude glucose from intravenous fluids. Adding some form of glucose is not standard practice today, but the time has come to do it, either by adding glucose to hydrating fluid or have women in labor eat and drink more,” said Dr. Main, medical director of the California Maternal Quality Care Collaborative in Stanford.
Dr. Paré reported having no financial disclosures.
On Twitter @mitchelzoler