The Effects of Increased IV Hydration on Nulliparous Women Undergoing an Induction of Labor
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 1/17/2019 |
| Start Date: | March 2016 |
| End Date: | June 2019 |
| Contact: | Vineet Shrivastava, MD |
| Email: | vshrivas@me.com |
| Phone: | (562) 997-8510 |
A Double-Blinded Randomized Controlled Trial on the Effects of Increased Intravenous Hydration on Nulliparous Women Undergoing an Induction of Labor
The objective of this study is to compare the effects of intravenous fluid rate on the course
of labor in nulliparous patients who are undergoing labor induction and have an unfavorable
cervix. The primary hypothesis is that an increased rate of intravenous fluids will shorten
the length of labor in patients undergoing induction with an unfavorable cervix.
of labor in nulliparous patients who are undergoing labor induction and have an unfavorable
cervix. The primary hypothesis is that an increased rate of intravenous fluids will shorten
the length of labor in patients undergoing induction with an unfavorable cervix.
Exercise physiology has shown that increased fluid intake and replacement can improve
skeletal muscle performance in prolonged exercise. Labor is a physically demanding process
that is essentially an "exercise" of the uterus, where uterine contractions of varying
strength and dilation lead to thinning and dilation of the cervix and to eventual delivery of
the infant. It has logically been theorized that, as with any exercise, improved hydration
and delivery of carbohydrates to uterine smooth muscle can help optimize the contractions
needed during labor. Conversely, dehydration is believed to result not only in decreased
uterine perfusion (due to decreased intravascular volume), but also in reduced delivery of
nutrients and elimination of waste products from the contracting myometrium.
Inadequate maternal hydration has been postulated to be a contributing factor to prolonged or
dysfunctional labor, in which uterine contractions are not sufficiently strong or are
inappropriately coordinated to cause adequate cervical dilation and effacement. Even in
patients who completely dilate, sufficient voluntary and involuntary muscle effort is
required during the second stage of labor to achieve a vaginal delivery. Prolonged labors can
not only lead to increased hospitalization cost, but also to increased risks of cesarean
delivery for indications such as "failure to progress," chorioamnionitis (intrauterine
infection), and postpartum hemorrhage. Establishing techniques to optimize the length and
duration of labor has therefore been an area of particular research interest.
To date, several randomized, controlled studies have demonstrated that with higher
intravenous (IV) fluid rates, there is a decreased frequency of prolonged labor and possibly
a decreased need for oxytocin in patients who present in active labor. One of these studies
was performed here at Long Beach Memorial by Garite et al under IRB approval and supervision.
Importantly, a systematic review of these studies by the Cochrane Collaboration in 2013
demonstrated that increased intravenous fluid rates (250mL/hr vs 125mL/hr) appears to shorten
the time to delivery and the cesarean delivery rate in patients who present in active labor.
The rate of induction of labor has increased dramatically in recent years, from 9.5% in 1990
to 22.1% in 2004. Women undergoing an induction of labor (whether elective or medically
indicated) represent a distinct population from those who present in active labor, not only
with regards to their baseline characteristics, but also with regards to their labor course
and maternal and neonatal outcomes. There have been no studies thus far investigating the use
of increased intravenous hydration in patients undergoing induction of labor, as previous
studies have focused on patients who present in active labor. The objective of this study is
therefore to determine the effect of increased intravenous hydration in nulliparous patients
undergoing an induction of labor on length of labor, mode of delivery, and other maternal and
neonatal outcomes.
skeletal muscle performance in prolonged exercise. Labor is a physically demanding process
that is essentially an "exercise" of the uterus, where uterine contractions of varying
strength and dilation lead to thinning and dilation of the cervix and to eventual delivery of
the infant. It has logically been theorized that, as with any exercise, improved hydration
and delivery of carbohydrates to uterine smooth muscle can help optimize the contractions
needed during labor. Conversely, dehydration is believed to result not only in decreased
uterine perfusion (due to decreased intravascular volume), but also in reduced delivery of
nutrients and elimination of waste products from the contracting myometrium.
Inadequate maternal hydration has been postulated to be a contributing factor to prolonged or
dysfunctional labor, in which uterine contractions are not sufficiently strong or are
inappropriately coordinated to cause adequate cervical dilation and effacement. Even in
patients who completely dilate, sufficient voluntary and involuntary muscle effort is
required during the second stage of labor to achieve a vaginal delivery. Prolonged labors can
not only lead to increased hospitalization cost, but also to increased risks of cesarean
delivery for indications such as "failure to progress," chorioamnionitis (intrauterine
infection), and postpartum hemorrhage. Establishing techniques to optimize the length and
duration of labor has therefore been an area of particular research interest.
To date, several randomized, controlled studies have demonstrated that with higher
intravenous (IV) fluid rates, there is a decreased frequency of prolonged labor and possibly
a decreased need for oxytocin in patients who present in active labor. One of these studies
was performed here at Long Beach Memorial by Garite et al under IRB approval and supervision.
Importantly, a systematic review of these studies by the Cochrane Collaboration in 2013
demonstrated that increased intravenous fluid rates (250mL/hr vs 125mL/hr) appears to shorten
the time to delivery and the cesarean delivery rate in patients who present in active labor.
The rate of induction of labor has increased dramatically in recent years, from 9.5% in 1990
to 22.1% in 2004. Women undergoing an induction of labor (whether elective or medically
indicated) represent a distinct population from those who present in active labor, not only
with regards to their baseline characteristics, but also with regards to their labor course
and maternal and neonatal outcomes. There have been no studies thus far investigating the use
of increased intravenous hydration in patients undergoing induction of labor, as previous
studies have focused on patients who present in active labor. The objective of this study is
therefore to determine the effect of increased intravenous hydration in nulliparous patients
undergoing an induction of labor on length of labor, mode of delivery, and other maternal and
neonatal outcomes.
Inclusion Criteria:
- Pregnant
- ≥ 18 years of age
- Singleton gestation
- Nulliparous
- Vertex presentation
- Gestational age ≥ 36 weeks
- Bishop score ≤ 6
- undergoing induction of labor
Exclusion Criteria:
- Multiparous
- Preeclampsia at admission
- Gestational or chronic hypertension
- Non-vertex presentation
- Multiple gestation
- Chorioamnionitis at admission
- Intrauterine growth restriction (<10th percentile)
- BMI > 50
- Presence of uterine scar
- Participation in any other research protocol involving induction of labor
- Nonreassuring fetal heart rate tracing at admission
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