IV Glucose vs. Oral Intake During Labor- a Collection of Abstracts
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J Perinat Med 2001;29(6):457-64 |
Books
Fetal and maternal energy metabolism during
labor in relation to the available caloric substrate.
Scheepers HC, de Jong PA, Essed GG, Kanhai HH.
Department of Gynecology and Obstetrics, Leyenburg Hospital, The Hague, The
Netherlands. HCJ.Scheepers@hetnet.nl
AIM: To discuss maternal and fetal metabolic events during labor and the
possible role of glucose administration. RESULTS: The oxidative pathway covers
the largest part of the energy demand of labor, although in the second stage
or, in polysystolic labor, the non-oxidative pathway becomes important as well.
Glucose is the main maternal energy source, but the rise in ketobodies, even
during normal labor, suggests a relative shortage. In the first stage of labor,
a combination of a respiratory alkalosis, and to a lesser extent, a metabolic
acidosis, result in a rise in the maternal pH. In the second stage of labor,
the maternal pH decreases due to an increasing metabolic acidosis. Glucose is
also the main fetal energetic fuel. In fetal hypoxia, lactate is produced,
which in most cases is transferred to the maternal circulation. High maternal
lactate concentrations, however, may interfere with this process. Furthermore,
fetal hyperglycemia may lead to an increased fetal lactate production.
CONCLUSIONS: Maternal hyperglycemia, may lead to an increase in maternal and
fetal lactate production resulting in metabolic acidosis. Unlike high dosage
intravenous glucose administration, it is not likely that oral intake of
carbohydrates leads to maternal and fetal hyperglycemia and subsequently to
metabolic acidosis, but studies are rare.
PMID: 11776675 [PubMed - in process]
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J Obstet Gynecol Neonatal Nurs 1999 Sep-Oct;28(5):507-12 |
Fasting in labor: relic or requirement.
Sleutel M, Golden SS.
Angelo State University in San Angelo, TX 76909, USA.
OBJECTIVE: To evaluate the scientific literature on restrictions of eating and
drinking during labor. DATA SOURCES: Computerized searches in MEDLINE and
CINAHL, as well as historical articles, texts, and references cited in
published works. Key words used in the searches included anesthesia in labor,
childbirth, eating and drinking, epidural, fasting, fasting in labor, fasting
and pregnancy, gastric aspiration, gastric emptying, intrapartum, intravenous
fluids, i.v.s in labor, ketonuria, ketonuria in labor, parturition, pregnancy,
and stomach contents in labor. STUDY SELECTION: Articles from indexed journals,
excluding single-person case studies. DATA EXTRACTION: Data were extracted and
organized under the following headings: historical review, effects of fasting
on labor, research on maternal mortality/morbidity from aspiration, research on
gastric emptying in labor, intravenous hydration in labor, and implications for
nursing research. DATA SYNTHESIS: Research does not support restricting food
and fluids in labor to prevent gastric aspiration. Restricting oral intake
during labor has unexpected negative outcomes. CONCLUSIONS: Little is known
about the differences in labor progress, birth outcomes, and neonatal status
between mothers who consume food and/or fluids during labor and women who fast
during labor. Research also is needed on the effects of epidural opioids on
gastric emptying, nutritional requirements during labor, and the physiologic
implications of fasting during labor. Fasting during labor is a tradition that
continues with no evidence of improved outcomes for mother or newborn. Many
facilities (especially birth centers) do not restrict eating and drinking.
Across the United States, most hospitals restrict intake, usually to ice chips
and sips of clear liquids. Anesthesia studies have focused on gastric emptying,
measured by various techniques, presuming that delayed gastric emptying
predisposes women to aspiration. Narcotic analgesia delays gastric emptying,
but results are conflicting on the effect of normal labor and of epidural
anesthesia on gastric emptying. The effect of fasting in labor on the fetus and
newborn and on the course of labor has not been studied adequately. Only one
study evaluated the probable risk of maternal aspiration mortality, which is
approximately 7 in 10 million births.
Publication Types:
· Review
· Review, Tutorial
PMID: 10507677 [PubMed - indexed for MEDLINE]
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J Nurse Midwifery 1993 Jul-Aug;38(4):228-35 |
Low-risk mothers. Oral intake and emesis in
labor.
O'Reilly SA, Hoyer PJ, Walsh E.
University of Michigan, School of Nursing, Division II/Parent-Child Nursing,
Ann Arbor 48109-0482.
This study examined the pattern of oral intake and its impact on emesis and
other complications in low-risk gravidas during labor. It is common clinical
practice to restrict oral intake in most institutions. The historical bases for
this restrictive practice are explored. Findings from this study indicate that
when given a choice, all 106 women chose a variety of types and amounts of oral
intake throughout all stages of labor. Over 80% of women who ate or drank
during labor had no emesis. Of the 20 who did have any emesis, 40% (eight)
vomited more than once. None of the women who vomited experienced poor
outcomes. These data suggest that women who choose oral intake during labor are
at relatively low risk for complications related to this intake. Based on a
comprehensive review of the literature and these study results, practitioners
should allow as much choice as is consistent with empirical knowledge and safe
practice.
PMID: 8410351 [PubMed - indexed for MEDLINE]