NORMAL SALINE FOR THE INTRAPARTUM MANAGEMENT OF THE INSULIN-DEPENDENTDIABETIC PATIENT

Objectives To evaluate the safety and efficacy of saline alone for the intrapartum management of insulin-requiring diabetic patients and the ir infants. Methods This was a retrospective evaluation of 77 insulin- requiring diabetic patients, over a 12-year period ending 1 January 19 94. All patients began labor, either induced or spontaneous, with an i ntravenous infusion of 0.9% saline, reserving insulin, and/or dextrose for patients with plasma glucose measurements consistently outside th e threshold values of 3.5 mmol/l (63 mg/dl) and 6.5 mmol/l (117 mg/dl) . Neonates were assessed for hypoglycemia and other complications. Res ults Forty-four patients (57%) had diabetes prior to their pregnancy, with a mean length of diabetes of 9.9 years. Neither insulin nor dextr ose was required in labor by 70.1% of mothers. Insulin-requiring gesta tional diabetic patients were more likely to remain euglycemic in labo r than those whose diabetes predated their pregnancy (87.9% vs. 56.8%, p = 0.005). Only one mother experienced transient symptoms of hypogly cemia. The incidence of neonatal hypoglycemia was 11.7%. Conclusions M ost insulin-requiring diabetic patients will remain euglycemic in labo r without insulin or dextrose. There were no major maternal consequenc es with this approach and the incidence of neonatal hypoglycemia was l ess than that usually quoted. The simplicity of this approach promotes safety and, in the majority of cases, decreases the cost and potentia l adverse effects of insulin and dextrose.