Effect of Intrapartum Normal Saline and Dextrose-saline Infusion on Course of Labour and Neonatal Outcomes Among Nulliparous Women in Kenyatta National Hospital

Abstract

ABSTRACT Background: Labor is associated with an increased demand for energy due to increased skeletal and smooth muscle contractions. Adequate hydration and optimal glucose levels improves muscle performance during vaginal delivery. However, parturients have little if any nutritional intake by mouth during labor. It is thus important to evaluate the impact of intra-partum dextrose infusion on labor and pregnancy outcomes. In this study, it was hypothesized that intra-partum dextrose-saline infusion will cause significant reduction in the length of labor; taking participants on intra-partum plain normal saline infusion as the control group. Objectives: The objective of the study was to compare the effect of intra-partum infusion of dextrose 5% in normal saline versus plain normal saline on the progression of labor and neonatal outcomes among nulliparous women admitted with spontaneous labor at the Kenyatta National hospital (KNH). Methodology: In this simple randomized, double blinded controlled trial conducted in KNH labor ward; 198 term, nulliparous women with singleton pregnancies in active phase of labor, were divided into two groups and scheduled to receive either 175mL/hour of 5% dextrose in normal saline or 175mL/hour of normal saline for the duration of labor. Course of labor was assessed by length of active phase of labor (cervical dilatation of ≥5cm to fully dilated cervix), need for augmentation of labor with oxytocin and mode of delivery. Neonatal outcomes were assessed by Apgar score at 5 minutes. The data was then entered into an excel sheet, cleaned and analyzed using R Software. The homogeneity of the socio demographic characteristics and APGAR scores was evaluated using one way ANOVA. A Chi Square test of association for the length of labor and duration of second stage was applied, while Fischer exact test was used to compare the mode of delivery. Results: A total of 204 participants were assessed for eligibility, out of which 6 were excluded. The 198 participants were enrolled (99 in each arm) and randomized for follow up; 90 participants were analyzed from each arm. The demographic and clinical characteristics of the participants across the two groups were similar. The mean duration for the active phase of labor was 5.73hrs (sd 2.25) for 5% DNS group and 5.94hrs (sd 2.66) for the NS group, p=0.268; this was not significant statistically. Though not significant statistically, patients in the 5% DNS arm were 18% less likely to labor for more than 5hours from onset of fluid administration (OR, 0.827, CI 0.41-1.66, p, 0.59). Patients in the 5% DNS arm were 2 times more likely to have oxytocin infused, (CI 0.82-4.29, p=0.13). Having an infusion with 5%DNS was associated with less CS and having a more favorable APGAR score (OR, 0.696, CI 0.35-1.38, p=0.298 and OR 0.101, CI 0.013-0.816, p=0.018 respectively). Additionally there was a statistically significant shorter duration of the second stage among patients on 5% DNS compared to those on NS infusion (OR , p=0.015) Conclusion: Administration of intra-partum dextrose containing intravenous fluid was not significantly associated with mean duration of active phase of labor, infusion with oxytocin and Cesarean delivery. Using 5% DNS however is significantly associated with a shorter duration of second stage of labor and better APGAR scores. From the study findings, use of dextrose containing intravenous fluid during labor does confer benefit on second stage of labor and neonatal outcomes over non-dextrose containing intravenous fluids. Key words: Labor Length, Dextrose 5% in saline, Normal Saline, Pregnancy Outcome