The Use of D5LR Versus LR for Induction of Labor and Time to Delivery in Multiparous and Primiparous Patient's With Favorable and Unfavorable Bishop's Scores

Ascension Health

Status: Completed

Conditions: Induction of Labor Affected Fetus / Newborn

Treatments: Other: 5% dextrose lactated ringers; Other: Lactated ringers

Study type: Interventional

Funder types: Industry

Identifiers

NCT03822052

ME 19 004

Details and patient eligibility

About

Currently, the optimum IV fluid for induction of labor is unknown. The goal of this study is to determine the optimum fluid for induction of labor, D5LR versus LR. The investigators hypothesize that patients assigned to the D5LR group will have a shorter induction of labor when compared to patient's in the LR group.

Full description

Induction of labor is increasingly common in the United States, as the overall rate has increased from 9.5% in 1990 to 22.1% in 2006 with the goal to stimulate contractions prior to the onset of spontaneous labor. Cesarean delivery rates are also at an all-time high in the U.S., with more than 32% of patients being delivered by Cesarean in 2009. One of the most common indications for Cesarean section is a prolonged labor course. Patient's with a prolonged labor course are also at risk for infections, including chorioamnionitis and endometritis, as well as an increased risk of postpartum hemorrhage. There is a lack of information on ways to help shorten labor to potentially minimize these risks.

The uterus is comprised of skeletal muscle, and labor has been likened to prolonged rigorous exercise. While oral hydration has been endorsed by ACOG for low-risk women in spontaneous labor, solid foods should be avoided. In turn, women with a prolonged induction or labor may benefit from glucose supplementation via IV fluids.

The DEXTRONS study, J. Pare et al., looked at supplementation of D5LR versus normal saline in nulliparous patients who presented for a favorable induction of labor. This study showed a significant reduction in active labor time in the D5LR group versus the normal saline group.

Currently, at Genesys Regional Medical Center, lactated ringers is the preferred IV fluid for patients presenting for induction of labor. This study will randomly assign patients to D5LR versus lactated ringers and examine the length of time from induction to delivery to determine if glucose supplementation has an effect on reducing length of induction in both nulliparous and multiparous patients for either a favorable induction of labor or an induction for post-dates. Secondary outcomes will include Apgar scores, need for special care nursery/NICU admissions, and mode of delivery. The study will begin in January 2019 and continue through July 2019. Patients who presented to labor and delivery and consent to be included in the study will be randomized to each group.

Enrollment: 39 patients

Sex: Female

Ages: 18 to 45 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Pregnant women, age 18 - 45, that were admitted for induction of labor without any co-morbid conditions and their respective newborns with
• Induction of labor
• Singleton pregnancies
• Vertex presentation
• Pregnancies at 39 0/7 weeks gestation - 41 6/7 weeks gestation
• All races/ethnicities

Exclusion criteria

• Multifetal gestations
• Noncephalic presentation
• Preexisting medical conditions:
• Maternal cardiac disease
• Lung diseases
• Chronic hypertension
• Pregestational or gestational diabetes
• gHTN or Pre-Eclampsia
• medical indication for induction of labor (olighydramnios, IUGR)

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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39 participants in 4 patient groups

Primiparous Patient, Unfavorable Bishop Score

Active Comparator group

Description:

Patient to receive D5LR or LR at 125 cc/hr

Treatment:

Other: 5% dextrose lactated ringers

Other: Lactated ringers

Primiparous Patient, Favorable Bishop Score

Active Comparator group

Description:

Patient to receive D5LR or LR at 125 cc/hr

Treatment:

Other: 5% dextrose lactated ringers

Other: Lactated ringers

Multiparous patient, Unfavorable Bishop Score

Active Comparator group

Description:

Patient to receive D5LR or LR at 125 cc/hr

Treatment:

Other: 5% dextrose lactated ringers

Other: Lactated ringers

Multiparous patient, Favorable Bishop Score

Active Comparator group

Description:

Patient to receive D5LR or LR at 125 cc/hr

Treatment:

Other: 5% dextrose lactated ringers

Other: Lactated ringers