INTRAPARTUM MATERNAL GLUCOSE-INFUSION REDUCES UMBILICAL-CORD ACIDEMIA

OBJECTIVE: Our purpose was to compare the effects of intrapartum 5% gl ucose in the intravenous fluid on umbilical cord acid-base and glucose status after spontaneous vaginal delivery. STUDY DESIGN: This was a p rospective randomized clinical tr:al in which gravid women with low-ri sk pregnancies at term were randomized by computer to receive lactated Ringer's solution, either with 5% glucose or without, as the maintena nce intravenous fluid during active labor. Antepartum and intrapartum factors that might influence fetal-neonatal glucose levels were record ed. Umbilical arterial cord blood was assessed for glucose level and a cid-base status. RESULTS: Of the 106 parturient patients who consented , 15 were excluded because of operative delivery (n = 8), preeclampsia (n = 2), shoulder dystoc:a (n = 1), intravenous fluid infusion durati on of <1 hour (n = 1), and cord blood data not available (n = 3). Ther e were no statistical differences between the two groups regarding mat ernal age, parity, maternal weight at term, epidural placement, intrav enous fluid duration, or gestational age. Infant birth weight, gender, Apgar scores, and incidence of meconium were not statistically differ ent. Neonatal hypoglycemic episodes and intrapartum fetal heart rate t racing parameters were similar between groups. The difference between the umbilical artery pH values of those who were treated with lactated Ringer's solution with 5% glucose (n = 48) versus those treated with the solution without glucose (n = 43) approached significance, with a p value of 0.08 (mean I SD, 7.30 +/- 0.07 and 7.27 +/- 0.09, respectiv ely). The Pco(2) value of those treated with lactated Ringer's solutio n without glucose was higher (mean +/- SD, 50.6 +/- 12.9 mm Hg vs 44.8 +/- 9.9 mm Hg) lo = 0.02). Base excess (in milliequivalents per decil iter) and cord glucose (in milligrams per deciliter) levels, as well a s the incidence of neonatal hypoglycemic episodes within the first 8 h ours of life, were not statistically different. Despite failure of mea n pH differences to achieve significance, the relative risk (0.22) for an umbilical arterial pH less than or equal to 7.20 was significantly reduced (95% confidence interval 0.1 to 0.7) with lactated Ringer's s olution containing 5% glucose. The relative risk (0.42) of having an u mbilical artery cord blood PCO2 value greater than or equal to 55 mm H g was also significantly lowered (95% confidence interval 0.19 to 0.93 ) when lactated Ringer's solution containing 5% glucose was used. CONC LUSIONS: Intrapartum intravenous fluid consisting of lactated Ringer's solution containing 5% glucose reduces umbilical cord acidemia and hy percarbia but does not change cord levels of glucose or base excess. L actated Ringer's solution containing 5% glucose may be a preferable so lution than without glucose as an intravenous fluid during labor.