Intervention Review

Interventions for ketosis during labour

  1. Jocelyn Toohill1,*,
  2. Barbara Soong2,
  3. Vicki Flenady3

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 31 JAN 2008

DOI: 10.1002/14651858.CD004230.pub2


How to Cite

Toohill J, Soong B, Flenady V. Interventions for ketosis during labour. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD004230. DOI: 10.1002/14651858.CD004230.pub2.

Author Information

  1. 1

    Gold Coast Hospital, Family, Women's and Children's, Southport, Queensland, Australia

  2. 2

    Mater Mothers' Hospital, Maternal Fetal Medicine Unit, South Brisbane, Queensland, Australia

  3. 3

    Mater Health Services, Translating Research Into Practice (TRIP) Centre - Mater Medical Research Institute, Woolloongabba, Queensland, Australia

*Jocelyn Toohill, Family, Women's and Children's, Gold Coast Hospital, 108 Nerang Street, Southport, Queensland, 4219, Australia. j.toohill@griffith.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 16 JUL 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

In labour, ketosis (the elevation of ketone bodies in the blood) is a common occurrence, due to increased physical stress, which is often compounded by reduced oral intake. The effect of ketosis on the mother and baby during labour is not clear, therefore, there is uncertainty as to whether ketosis is a normal physiological response or whether women with ketosis in labour require intervention (such as intravenous fluids or increased oral intake) for maternal and infant wellbeing. This uncertainty has resulted in differences in opinion and practice by those providing care for women in labour.

Objectives

To assess the effects on maternal, fetal and neonatal outcomes of intravenous fluids or increased oral intake administered to women in labour for the treatment of ketosis compared with no intervention (defined as no oral intake, ice chips only, or oral intake on demand) and to also assess the effects of different types of intravenous fluids administered.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008), CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE (1950 to January 2007), EMBASE (1988 to January 2007) and CINAHL (1982 to 2007).

Selection criteria

All published and unpublished randomised trials in which additional oral intake or intravenous fluids, or both, were used for the treatment of women with ketosis in labour.

Data collection and analysis

Two authors independently assessed potentially eligible trials. The authors sought additional information on trial methods and outcome data to enable consideration of eligibility of studies. However, at the time of the review, no information was received.

Main results

We identified six trials as potentially eligible for inclusion in this review. All six studies were excluded. Therefore no trials are included in this review.

Authors' conclusions

There is no information on which to base practice in the treatment of women with ketosis during labour. Further research is required to identify more clearly the association between ketosis in labour and pregnancy outcome. Future trials should examine the effects of no interventions and different types of intravenous and oral fluids on these clinically important outcomes, and include women's perception and satisfaction with care during labour and birth.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions for ketosis during labour

Physical stress compounded by reduced food intake during labour can lead to raised levels of ketones in the blood and urine (ketosis). Ketone bodies transport fat-derived energy from the liver to other organs to provide an alternative source of energy. They also cross the placenta and the effect of ketosis on mother and baby is not clear. It is not clear whether ketosis during labour is a normal physiological response, or if women with ketosis in labour require intervention (such as intravenous and oral fluids). This uncertainty has resulted in differences in opinion and practice. Adverse effects of ketosis for the mother include increased likelihood of augmentation of labour, forceps-assisted delivery and postpartum blood loss.

Yet intravenous therapies can have adverse effects, either by interfering with glucose and insulin levels for the mother and infant (causing neonatal hypoglycaemia) or lowering sodium level, for example. Other reported adverse effects include headache, nausea, maternal fluid overload, slowing of labour and difficulty in establishment of breastfeeding, as well as local pain and discomfort and interference with the woman's freedom of movement in labour. The newborn may have acidic blood and increased lactate levels.

This review found no information on which to base practice in the treatment of women with ketosis during labour. The authors looked for studies comparing oral intake or intravenous fluids with no intervention (defined as no oral intake, ice chips only or oral intake on demand) and pregnancy outcomes.

The only six studies identified focussed on maternal biochemical measures during or shortly after labour and could not be included in the review. The studies were conducted in the late 1970s to mid-1980s. Future trials should examine the use of different types of intravenous and oral fluids on clinically important outcomes and include women's perception and satisfaction with care during labour and birth.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

分娩期間發生的酮症之干預措施

在分娩過程中,酮症(血液中酮體的量增加)是經常發生的情況,這是由於身體的壓力所致,通常會因為飲食量減少而加劇。目前仍未釐清酮症在分娩期間,對於母親和嬰兒造成的影響,因此還不確定酮症是否為正常的生理反應,或是在分娩期間發生酮症的女性,是否需要進一步處理(例如靜脈輸液或增加經口攝食量),來促進母親和嬰兒的健康。這樣的不確定性會導致女性分娩期間,醫療人員之觀點和臨床操作上的差異。

目標

本篇回顧的目的是評估女性分娩期間,進行靜脈輸液或增加經口攝食量以治療酮症,對於母親、胎兒和新生兒預後的影響,與未進行干預措施的情況比較之(定義為沒有經口攝食、只給予冰塊,或是只根據產婦的要求讓她經口攝食),同時也評估不同類型的靜脈輸液所造成的影響。

搜尋策略

我們搜尋了Cochrane Pregnancy and Childbirth Group's Trials Register (2008年1月)、CENTRAL (The Cochrane Library 2007, Issue 2)、MEDLINE (1950年至2007年1月)、EMBASE (1988年至2007年1月)和CINAHL (1982年至2007年)等資料庫。

選擇標準

所有已發表和未發表的隨機試驗,利用額外的經口攝食或靜脈輸液,或同時使用這兩種方法,來治療女性分娩期間發生的酮症。

資料收集與分析

2位作者獨立地評估可能合格的試驗。作者針對試驗方法和結果的資料來尋找額外的資訊,以考慮該試驗是否合格。然而,在進行回顧時,並未獲得相關資訊。

主要結論

我們發現了6項可能合乎本回顧之收納資格的試驗。但是6項研究全都被排除了。所以本篇回顧並未包含任何試驗。

作者結論

沒有任何資訊可當作女性分娩期間,發生酮症之治療參考依據。還需要進一步研究,以清楚地確認分娩期間發生酮症與懷孕結果間的關連性。未來的試驗需要審查未進行干預,以及不同類型之靜脈輸液及經口攝取液體,對於這些臨床上的重要結果,並且包括女性在分娩及生產期間,對於醫療照顧之感覺和滿意度所造成的影響。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

分娩期間減少的攝食量,再加上身體受到的壓力加劇,因此可能導致血液及尿液中的酮含量增加(酮症)。酮體可以將脂肪所獲得的能量,從肝臟運輸到其他器官,以提供替代的能量來源。它們也會穿越胎盤,然而酮症對於母親和嬰兒的影響仍未釐清。目前還不清楚分娩期間的酮症是否為正常的生理反應,或是女性在分娩期間發生酮症,是否需要治療措施(例如靜脈輸液和經口攝取液體)。這種不確定性會導致醫療人員之意見和臨床實作上的差異。酮症對於母親造成的不良影響包括延長分娩時間、增加需要產鉗助產的可能性及增加產後的出血量。 但是靜脈注射治療可能造成一些不良的影響,例如,可能會影響母親和嬰兒的葡萄糖和胰島素含量(導致新生兒的低血糖),或降低鈉含量。其他提出的不良影響包括頭痛、噁心、母親體液過量、分娩速度變慢、以及難以順利地開始哺乳,以及局部疼痛和不適,以及影響母親分娩時移動的自由度。新生兒的血液也可能偏酸,並且增加乳酸鹽的含量。 這篇回顧並未找到任何資訊,可當作女性分娩期間發生酮症之治療參考依據。作者尋找比較經口攝取或靜脈輸液的干預措施與未進行干預(定義為沒有經口攝食、只給予冰塊,或是只根據產婦的要求讓她經口攝食)及懷孕的結果。唯一辨認出的6項研究,將重點放在母親分娩時及分娩後立即測得的生物化學測量值,因此無法收納於本回顧中。這些試驗是在70年代末期至80年代中期進行的。未來的試驗應審查利用不同類型之靜脈輸液及經口攝取液體,對於臨床重要結果的影響,同時包括女性在分娩和生產期間的感覺和滿意度。