The effect of type and volume of fluid hydration on labor duration of nulliparous women: a randomized controlled trial

Garmi, Gali; Zuarez-Easton, Sivan; Zafran, Noah; Ohel, Iris; Berkovich, Ilanit; Salim, Raed

doi:10.1007/s00404-017-4381-1

Cited by 6 publications

(19 citation statements)

References 19 publications

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“…As a result of the screening process, n = 25 articles were excluded by assessing the full texts (n = 36), and finally 11 RCTs met the inclusion criteria in this meta-analysis (Figure 1). 5,[12][13][14][15][16][17][18][19][20][21]…”

Section: Search Results and Study Selectionmentioning

confidence: 99%

Intravenous fluid rate of 250 mL/h versus 125 mL/h in nulliparous women: A systematic review and meta‐analysis of randomized controlled trials

Imran,

Kamran,

Fakih

et al. 2023

Intl J Gynecology & Obste

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BackgroundEvidence regarding the type and rate of intravenous (IV) fluid administration during labor is still inconclusive and the studies assessing the impact of IV fluids had mixed results.ObjectivesTo evaluate the effects of IV fluids at an infusion rate of 250 mL/h as compared with 125 mL/h on labor outcomes in nulliparous women.Search StrategyWe searched six databases for relevant studies through a search strategy containing the relevant keywords “IV hydration”, “IV fluids”, and “labor” from the inception of these databases to May 1, 2023, without any applied restrictions.Selection CriteriaSearch results were imported to Covidence for screening of eligible articles for this review. Randomized controlled trials (RCTs) assessing the impact of IV fluids at 250 mL/h on the outcomes of labor in nulliparous women at term (>37 weeks) as compared with 125 mL/h were included only.Data Collection and AnalysisData regarding the characteristics of included studies, participant's baseline characteristics, and concerned outcomes were collected in an Excel spreadsheet and all the concerned outcomes were pooled as risk ratios (RR) or mean difference (MD) with 95% confidence interval (CI) in the meta‐analysis models using RevMan 5.4.Main resultsPooled data from 11 RCTs with 1815 patients showed that 250 mL/h infusion rate had a significant reduction in cesarean section rate (RR 0.70, 95% CI 0.56–0.88, P = 0.002), the first stage of labor duration (MD –46.97, 95% CI –81.79 to −12.14, P = 0.008), the second stage of labor duration (MD –2.69, 95% CI –4.34 to −1.05, P = 0.001), prolonged labor incidence (RR 0.72, 95% CI 0.58–0.89, P = 0.003), as compared with 125 mL/h. Also, the vaginal delivery rate (RR 1.07, 95% CI 1.02–1.12, P = 0.009) was higher with a 250 mL/h infusion rate.ConclusionIV fluids at an infusion rate of 250 mL/h during labor in nulliparous women decreased the cesarean delivery rate, increased the vaginal delivery rate, shortened the first and second‐stage labor duration, decreased the incidence of prolonged labor as compared with 125 mL/h. These findings suggest enhanced labor progression and a lower risk of labor complications with higher infusion rates. However, future research involving a more diverse population and exploring the potential benefits of combining IV infusion rates with other interventions, such as adding dextrose or less restrictive oral intake during labor, is needed.

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Section: Search Results and Study Selectionmentioning

confidence: 99%

Intravenous fluid rate of 250 mL/h versus 125 mL/h in nulliparous women: A systematic review and meta‐analysis of randomized controlled trials

Imran,

Kamran,

Fakih

et al. 2023

Intl J Gynecology & Obste

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“…Variation existed between ruptured membrane status, with two of the three studies including participants with or without ruptured membranes. 20,22 Duffy et al conducted a randomized controlled trial comparing the rate of isotonic fluid administration in nulliparous women undergoing induction of labor (n = 180) in the USA. 21 They compared 125 mL/h with 250 mL/h isotonic fluid in a cohort of 180 healthy women.…”

Section: Re Sultsmentioning

confidence: 99%

“…The study by Garmi et al (n = 300) was conducted in Israel, and aimed to also examine the effect of a change in IVT fluid rate on the duration of labor. 20 Routine care (125 mL/h Ringer's lactate) was compared with two other regimens: 250 mL/h Ringer's lactate and 125 mL/h saline with 5% glucose. 20 Both studies found no significant improvements in duration of labor when women were provided with a higher rate of IVT, within populations of nulliparous women undergoing induction of labor.…”

Section: Re Sultsmentioning

confidence: 99%

“…No studies reported a significant difference in neonatal weight loss within the first 3 days. Although all three studies reported neonatal birthweight, only Garmi et al 20 reported neonatal weight at discharge, allowing for a comparison of weight loss between control and intervention groups. A significant difference in neonatal weight loss was found between the Ringer's 125 mL/h and Ringer's 250 mL/h groups (p = 0.011), with neonates losing more weight when the maternal IVT rate was 250 mL/h.…”

Section: Re Sultsmentioning

confidence: 99%

“…Our planned comparisons were: (1) Maternal: overall length of labor (two studies); duration of second stage of labor (two studies); and mode of birth (two studies); (2) Neonatal: weight loss within the first 72 h following birth (one study only) and breastfeeding-initiation and duration (not reported in any included study). We only included two studies (n = 375) in the metaanalysis; 20,21 the Pare et al study 22 was not included because of heterogeneity in the intervention. Overall length of labor varied between studies, but no significant difference was found in duration of labor from study enrolment to any birth between the intervention (250 mL/h) and control (125 mL/h) groups (mean difference −0.07, 95% CI −0.27 to 0.13) (Figure 3).…”

Section: Meta-analysismentioning

confidence: 99%

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The effects of intravenous hydration regimens in nulliparous women undergoing induction of labor: A systematic review and meta‐analysis

Kearney,

Brady,

Marsh

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionLabor is both a physiological and physical activity that requires energy expenditure by the woman. Despite this, women are often fasted in labor, with hydration requirements addressed predominantly by intravenous therapy. Little is known about how best to manage this in nulliparous women undergoing induction of labor, who can be prone to lengthy labors. Therefore, we undertook a systematic review and meta‐analysis to determine the effects of intravenous hydration regimens on nulliparous women undergoing induction of labor.Material and methodsA systematic review and meta‐analysis were conducted. Databases searched were PubMed, CINAHL, Embase, Cochrane, Scopus, and Web of Science using the search strategy combination of associated key concepts for intravenous therapy and nulliparous laboring women. The primary outcome was excessive neonatal weight loss. Meta‐analyses for categorical outcomes included estimates of odds ratio (OR) and their 95% confidence intervals (CI) calculated; and for continuous outcomes the standardized mean difference, each with its 95% CI. Heterogeneity was assessed visually and by using the χ2 statistic and I2 with significance being set at p < 0.10.ResultsA total of 1512 studies were located and following screening, three studies met the eligibility criteria. No studies reported excessive neonatal weight loss. Increased rates of intravenous therapy (250 mL/h vs. 125 mL/h) during labor were not found to reduce the overall length of labor (mean difference −0.07 h, 95% CI −0.27 to 0.13 h) or reduce cesarean sections (OR 0.74, 95% CI 0.45–1.23), when women were not routinely fasted.ConclusionsOur review found no significant improvements for nulliparous women who received higher intravenous fluid volumes when undergoing induction of labor and were not routinely fasted. However, data are limited, and further research is needed.

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A double-blinded randomized controlled trial on the effects of increased intravenous hydration in nulliparas undergoing induction of labor

Duffy

Fong

et al. 2022

American Journal of Obstetrics and Gynecology

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The effect of type and volume of fluid hydration on labor duration of nulliparous women: a randomized controlled trial

Abstract: ClinicalTrials.gov, http://www.clinicaltrials.gov , NCT01242293.

Cited by 6 publications

References 19 publications

Intravenous fluid rate of 250 mL/h versus 125 mL/h in nulliparous women: A systematic review and meta‐analysis of randomized controlled trials

Intravenous fluid rate of 250 mL/h versus 125 mL/h in nulliparous women: A systematic review and meta‐analysis of randomized controlled trials

The effects of intravenous hydration regimens in nulliparous women undergoing induction of labor: A systematic review and meta‐analysis

A double-blinded randomized controlled trial on the effects of increased intravenous hydration in nulliparas undergoing induction of labor

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