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

Jennifer Y Duffy; Erica Wu; Alex Fong; Thomas J Garite; Vineet K Shrivastava

doi:10.1016/j.ajog.2022.01.024

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

Am J Obstet Gynecol. 2022 Aug;227(2):269.e1-269.e7. doi: 10.1016/j.ajog.2022.01.024. Epub 2022 Jan 31.

Authors

Jennifer Y Duffy¹, Erica Wu², Alex Fong³, Thomas J Garite⁴, Vineet K Shrivastava⁵

Affiliations

¹ Department of Obstetrics and Gynecology, University of California, Irvine, CA; Miller Children's and Women's Hospital, Long Beach, CA. Electronic address: jennifer.duffy@ucsf.edu.
² Department of Obstetrics and Gynecology, Stanford University, Stanford, CA.
³ Department of Maternal-Fetal Medicine, Kaiser Permanente Irvine Medical Center, Irvine, CA.
⁴ Department of Obstetrics and Gynecology, University of California, Irvine, CA.
⁵ Miller Children's and Women's Hospital, Long Beach, CA.

PMID: 35114186
DOI: 10.1016/j.ajog.2022.01.024

Abstract

Background: Rates of labor induction are increasing, raising concerns related to increased healthcare utilization costs. High-dose intravenous fluid (250 cc/h) has been previously demonstrated to shorten the time to delivery in nulliparous individuals in spontaneous labor. Whether or not this relationship exists among individuals undergoing induction of labor is unknown.

Objective: Our study aimed to evaluate the effect of high-dose intravenous hydration on time to delivery among nulliparous individuals undergoing induction of labor.

Study design: Nulliparous individuals presenting for induction of labor with a Bishop score of ≤6 (with and without rupture of membranes) were randomized to receive either 125 cc/h or 250 cc/h of normal saline. The primary outcome was length of labor (defined as time from initiation of study fluids to delivery). Both time to overall delivery and vaginal delivery were evaluated. Secondary outcomes included the lengths of each stage of labor, the percentage of individuals delivering within 24 hours, and maternal and neonatal outcomes, including cesarean delivery rate.

Results: A total of 180 individuals meeting inclusion criteria were enrolled and randomized. Baseline demographic characteristics were similar between groups; however, there was a higher incidence of diabetes mellitus in the group receiving 125 cc/h. Average length of labor was similar between groups (27.6 hours in 250 cc/h and 27.8 hours in 125 cc/h), as was the length of each stage of labor. Cox regression analysis did not demonstrate an effect of fluid rate on time to delivery. Neither the admission Bishop score, body mass index, nor other demographic characteristics affected time to delivery or vaginal delivery. There were no differences in maternal or neonatal outcomes, including overall cesarean delivery rate, clinically apparent iatrogenic intraamniotic infection, Apgar scores, need for neonatal phototherapy, or neonatal intensive care unit stay.

Conclusion: There were no observed differences in the length of labor or maternal or neonatal outcomes with the administration of an increased rate of intravenous fluids among nulliparous individuals undergoing induction of labor.

Keywords: hydration; induction; intravenous fluids; labor; labor duration; nullipara; obstetrics; pregnancy.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Cesarean Section
Delivery, Obstetric
Female
Humans
Infant, Newborn
Labor, Induced
Labor, Obstetric*
Parity
Pregnancy