A randomized controlled trial to study the effect of IV hydration on the duration of labor in nulliparous women. A randomized trial of increased intravenous hydration in labor when oral fluid is unrestricted. Hyponatraemia and non-electrolyte solutions in labouring primigravida. Increased intravenous hydration of nulliparas in labor. A randomized, double-blinded, controlled trial comparing parenteral normal saline with and without dextrose on the course of labor in nulliparas. A randomized controlled trial of the effect of increased intravenous hydration on the course of labor in nulliparous women. Increased intravenous fluid intake and the course of labor in nulliparous women.
To compare the effects of two different regimens of intravenous hydration and oral hydration on the duration of active labor.
                Two hundred and ninety-three low risk term primigravida in active labor were randomized into three groups. The first group had 99 patients who received oral fluids only, the second group of 98 patients received intravenous Ringer lactate at the rate of 125 ml/h (IV 125 ml) and the third group had 96 patients who received intravenous Ringer lactate at a rate of 250 ml/h (IV 250 ml). Amniotomy and oxytocin administration were allowed according to the physician's discretion.
                The mean duration of labor in the oral fluid group was 391, 363 min in the 125 ml/h group and 343 min in the 250 ml/h group, P = 0.203. The incidence of prolonged labor more than 12 h in the oral fluid group was 7.1% in the oral fluid group, 4.1% in the 125 ml/h group and 3.1% in the 250 ml/h group, P = 0.402. The oxytocin requirement was 37% in the oral group, 32% in the 125 ml/h group and 33% in the 250 ml/h group, P = 0.68. There was a statistically significant reduction in the incidence of vomiting in patients receiving intravenous hydration, i.e. 24.2% in the oral group, 11.2% in the 125 ml/h group and 6.3% in the 250 ml/h group, P = 0.001. There was no difference in the mode of delivery, maternal or neonatal complications between the three groups.
                This study establishes a trend towards decreased incidence of prolonged labor and less vomiting in patients receiving intravenous hydration. Increased intravenous (IV) hydration is associated with decreased labor duration and oxytocin augmentation in nulliparous women when oral fluid is restricted. The objective of this study was to determine the effect of increased IV hydration on the duration of labor when access to oral fluid was unrestricted.
                Term, nulliparous women with uncomplicated singleton pregnancies were randomly assigned to receive lactated ringers at 250 ml per hour (IV fluid group) throughout active labor or usual care. All women were allowed unrestricted access to oral fluids.
                Eighty women completed the study, 37 in the IV fluid group and 43 in the usual care group. There was no difference in the primary outcome of total duration of labor (9.5 versus 9.4 hours) or in the secondary outcomes of duration of the first stage (7.9 versus 8.0 hours), duration of second stage (1.6 versus 1.4 hours), or rate of oxytocin augmentation (51% versus 44%).
                Increased IV hydration does not decrease labor duration in nulliparous women when access to oral fluid is unrestricted. We performed a prospective randomised study on one hundred primigravid women who required oxytocin to augment labour, comparing dextrose infusion with normal saline. After delivery, the 45 patients whose oxytocin was infused in dextrose had significantly lower serum sodium levels in both mother and baby compared to the 48 patients who had their oxytocin administered in normal saline. This was particularly evident in those cases where epidural analgesia was employed. To assess the effects of intravenous hydration on the duration of active labor in nulliparous women also allowed unrestricted oral consumption of fluids.
                In a randomized clinical trial 120 nulliparous women with uncomplicated singleton pregnancies at term were randomly assigned to drink fluids at will and receive either no intravenous hydration (group 1) or a Ringer lactate solution at rates of 60 mL, 120 mL, or 240 mL per hour (groups 2-4) throughout active labor.
                There were differences in duration for the active phase of the first stage of labor (252.3 ± 40.9 min in group 1 vs 206.7±38.3 min in group 4; P<0.001) and for the second stage (64.3 ± 13.9 in group 1 vs 49.8 ± 11.4 min in group 4; P=0.01), but not for the third stage. The percentage of participants who needed labor augmentation with oxytocin was less when intravenous hydration was provided (53.3% in group 1 vs 20.0% in group 4; P=0.02).
                Intravenous hydration significantly decreased the duration of active labor and reduced the frequency of both prolonged labor and oxytocin administration in nulliparous women. htpp://www.irct.ir registration number: IRCT201105256575N2.
                Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. The objective of the study was to compare intravenous normal saline with and without dextrose on the course of labor in nulliparae.
                In a double-blinded, controlled trial, term, nulliparae with singletons in active labor were randomized into 1 of 3 groups receiving either normal saline (NS), NS with 5% dextrose (D5NS), or NS with 10% dextrose (D10NS) at 125 mL/h. The primary outcome was total length of labor from onset of study fluid in vaginally delivered subjects. Maternal and neonatal outcomes were also analyzed.
                Of 300 subjects enrolled, 289 met inclusion criteria and completed the study. In vaginally delivered subjects, significant differences were noted in the second stage (P = .01) and total length of labor (P = .02). No significant differences were observed in the cesarean section rates between the groups (P = .21). No differences were noted in maternal or neonatal secondary outcomes.
                Administration of a dextrose solution, regardless of concentration, was associated with a shortened labor course in term vaginally delivered nulliparae subjects in active labor. One variable that has the potential to affect the course of labor but has not been evaluated previously is the adequacy of maternal hydration. Typical orders provide for 125 mL of intravenous fluids per hour in patients taking limited oral fluids. Many such patients are clinically dehydrated. Physiologists have shown that increased fluids improve skeletal muscle performance in prolonged exercise. This study was designed to determine whether increased intravenous fluids affect the progress of labor.
                Nulliparous women with uncomplicated singleton gestations at term, in spontaneous active labor with dilatation between 2 and 5 cm, and with a cephalic presentation were included. Patients who gave consent were randomly selected to receive either 125 mL or 250 mL of intravenous fluids per hour.
                One hundred ninety-five patients were randomly selected, 94 to the 125-mL group and 101 to the 250-mL group. Prerandomization variables were well matched between the 2 groups. The mean volume of total intravenous fluids was significantly greater in the 250-mL group (2008 mL vs 2487 mL; P =.002), as was the mean hourly rate (152 mL/h in the 125-mL group vs 254 mL/h in the 250-mL group; P =.001). The frequency of labor lasting >12 hours was statistically higher in the 125-mL group (20/78 [26%] vs 12/91 [13%]; P =.047). In addition, there was a trend favoring longer mean duration of the first stage and total duration of labor in patients delivered vaginally in the 125-mL group, by 70 and 68 minutes, respectively (P =.06). There was a trend toward a lower frequency of oxytocin administration for inadequate labor progress in the higher fluid rate group (61 [65%] in the 125-mL group vs 51 [49%] in the 250-mL group; P =.06). Cesarean deliveries were more frequent in the 125-mL group (n = 16) than in the 250-mL group (n = 10) but did not reach statistical significance.
                This study presents the novel finding that increasing fluid administration for nulliparous women in labor above rates commonly used is associated with a lower frequency of prolonged labor and possibly less need for oxytocin. Thus inadequate hydration in labor may be a factor contributing to dysfunctional labor and possibly cesarean delivery. Consideration of this factor in clinical management and in future studies considering variables that affect labor is warranted. To compare the effect of 2 regimens of intravenous fluid therapy on the course of labor.
                In a prospective, randomized, double-blind study of 300 nulliparous pregnant women at term conducted at a teaching hospital, 153 women received 125 mL and 147 received 250 mL of intravenous fluid per hour. The groups were matched and analysis was done using the t, chi(2), and Fisher exact tests. P<0.05 was considered statistically significant.
                In the group that received intravenous fluid at a rate of 250 mL per hour the mean+/-S.D. duration of labor was significantly shorter (253+/-97 vs. 386+/-110 min; P = 0.0001), the frequency of labor lasting both more than 10h and more than 15 h was statistically lower (4.8% vs. 13.8%; P=0.001 and 0% vs. 4.5%; P=0.02, respectively), and the frequency of oxytocin administration was significantly lower (8.1% vs. 20.4%; P=0.001). There was a trend toward a lower frequency of cesarean deliveries in the 250-mL group (16% vs. 22.8%; P=0.1).
                A greater volume per hour of intravenous fluid than is commonly administered to nulliparous women in active labor is associated with significantly shorter duration of labor and lower frequency of both prolonged labor and oxytocin administration.
Although the administration of intravenous fluids compared with oral intake alone demonstrated a reduction in the duration of labour, this finding emerged from only two trials. The findings of other trials suggest that if a policy of no oral intake is applied, then the duration of labour in nulliparous women may be shortened by the administration of intravenous fluids at a rate of 250 mL/hour rather than 125 mL/hour. However, it may be possible for women to simply increase their oral intake rather than being attached to a drip and we have to consider whether it is justifiable to persist with a policy of 'nil by mouth'. One trial raised concerns about the safety of dextrose and this needs further exploration.
None of the trials reported on the evaluation of maternal views of being attached to a drip during their entire labour. Furthermore, there was no objective assessment of dehydration. The evidence from this review does not provide robust evidence to recommend routine administration of intravenous fluids. Interpreting the results from trials was hampered by the low number of trials contributing data and by variation between trials. In trials where oral fluids were not restricted there was considerable variation in the amount of oral fluid consumed by women in different arms of the same trial, and between different trials. In addition, results from trials were not consistent and risk of bias varied. Some important research questions were addressed by single trials only, and important outcomes relating to maternal and infant morbidity were frequently not reported.