Carbohydrate solution intake during labour just before the start of the second stage: a double-blind study on metabolic effects and clinical outcome.

Abstract

To study the effects of oral carbohydrate ingestion on clinical outcome and on maternal and fetal metabolism. Prospective, double-blind, randomised study. Leyenburg Hospital, The Hague, The Netherlands. Two hundred and two nulliparous women. In labour, at 8 to 10 cm of cervical dilatation, the women were asked to drink a solution containing either 25 g carbohydrates or placebo. In a subgroup of 28 women, metabolic parameters were measured. Number of instrumental deliveries, fetal and maternal glucose, free fatty acids, lactate, pH, Pco2, base excess/deficit and beta-hydroxybutyrate. Drinking a carbohydrate-enriched solution just before starting the second stage of labour did not reduce instrumental delivery rate (RR 1.1, 95% CI 0.9-1.3). Caesarean section rate was lower in the carbohydrate group, but the difference did not reach statistical significance (1% vs 7%, RR 0.2, 95% CI 0.02-1.2). In the carbohydrate group, maternal free fatty acids decreased and the lactate increased. In the umbilical cord there was a positive venous-arterial lactate difference in the carbohydrate group and a negative one in the placebo group, but the differences in pH and base deficit were comparable. Intake of carbohydrates just before the second stage does not reduce instrumental delivery rate. The venous-arterial difference in the umbilical cord suggested lactate transport to the fetal circulation but did not result in fetal acidaemia.