Carbohydrate solution intake during labour just before the start of the second stage: a double‐blind study on metabolic effects and clinical outcome

Abstract

Objective To study the effects of oral carbohydrate ingestion on clinical outcome and on maternal and fetal metabolism. Design Prospective, double-blind, randomised study.Setting Leyenburg Hospital, The Hague, The Netherlands.Population Two hundred and two nulliparous women. MethodsIn labour, at 8 to 10 cm of cervical dilatation, the women were asked to drink a solution containing either 25 g carbohydrates or placebo. In a subgroup of 28 women, metabolic parameters were measured. Main outcome measures Number of instrumental deliveries, fetal and maternal glucose, free fatty acids, lactate, pH, Pco 2 , base excess/deficit and h-hydroxybutyrate. Results Drinking a carbohydrate-enriched solution just before starting the second stage of labour did not reduce instrumental delivery rate (RR 1.1, 95% CI 0.9-1.3). Caesarean section rate was lower in the carbohydrate group, but the difference did not reach statistical significance (1% vs 7%, RR 0.2, 95% CI 0.02 -1.2). In the carbohydrate group, maternal free fatty acids decreased and the lactate increased. In the umbilical cord there was a positive venous -arterial lactate difference in the carbohydrate group and a negative one in the placebo group, but the differences in pH and base deficit were comparable. Conclusion Intake of carbohydrates just before the second stage does not reduce instrumental delivery rate.The venous -arterial difference in the umbilical cord suggested lactate transport to the fetal circulation but did not result in fetal acidaemia.

Effect of food intake during labour on obstetric outcome: randomised controlled trial

“…A later study by Scheepers et al investigated the impact of intake of carbohydrate solution just before the start of the second stage of labour on maternal and fetal metabolism and clinical outcome and found no differences in the rates of instrumental and caesarean delivery between the groups. 25 The other three trials that have evaluated calorific intake during labour showed no significant effect on labour or neonatal outcome but were not sufficiently powered to evaluate these outcomes. 14 15 17 Scrutton et al showed that eating in labour prevented the development of ketosis but significantly increased residual gastric volume, 14 whereas Kubli et al showed that isotonic drinks reduced maternal ketosis during labour without increasing gastric volume.…”

Hyponatremia complicating labour—rare or unrecognised? A prospective observational study

“…Hyponatraemia during labour, now less frequently iatrogenic, is more often caused by overdrinking 12–14,31. Our study was therefore designed to evaluate the prevalence of hyponatraemia during modern management of labour.…”

Before labor and first stage of labor

“…Umbilical cord studies revealed lactate transport to the fetal circulation with potential (but not observed) fetal academia (31,32). These results should be interpreted with caution as the sample size was small, and there is conflicting evidence on the effects of these carbohydrate drinks.…”

“…A carbohydrate (mean intake 44 g in 350 mL) drink in early labor is associated with an increased risk of CD compared to placebo in women allowed to drink "at will" (31), but a carbohydrate (25 g) drink in late (8-10 cm) labor is associated with similar rates of CD compared to placebo (32). Umbilical cord studies revealed lactate transport to the fetal circulation with potential (but not observed) fetal academia (31,32).…”