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Intravenous fluids for reducing the duration of labour in low risk nulliparous women

  1. Feroza Dawood1,*,
  2. Therese Dowswell2,
  3. Siobhan Quenby3

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 18 JUN 2013

Assessed as up-to-date: 17 JUN 2013

DOI: 10.1002/14651858.CD007715.pub2


How to Cite

Dawood F, Dowswell T, Quenby S. Intravenous fluids for reducing the duration of labour in low risk nulliparous women. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD007715. DOI: 10.1002/14651858.CD007715.pub2.

Author Information

  1. 1

    Liverpool Women's NHS Foundation Trust, Liverpool, UK

  2. 2

    The University of Liverpool, Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, Liverpool, UK

  3. 3

    University of Warwick, Clinical Sciences Research Institute, Coventry, UK

*Feroza Dawood, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, L8 7SS, UK. feroza.dawood@lwh.nhs.uk. fdawood@liv.ac.uk.

Publication History

  1. Publication Status: New
  2. Published Online: 18 JUN 2013

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Characteristics of included studies [ordered by study ID]
Alavi 2005

MethodsProspective randomised clinical trial.


Participants194 nulliparous women in term spontaneous labours with a singleton pregnancy, cephalic presentation.

112 women received 125 mL/hour; 82 women received 250 mL/hour.


Interventions125 mL/hour vs 250 mL/hour of normal saline in dextrose water.


OutcomesDuration of labour in minutes; CS due to failure to progress.


NotesNo other oral intake; no food.

No epidurals.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskWomen were randomised but the study does not specify method of randomisation.

Allocation concealment (selection bias)Unclear riskPossible selection bias. Unclear details.

Incomplete outcome data (attrition bias)
All outcomes
Low riskNo attrition reported.

Selective reporting (reporting bias)Low riskFairly transparent results.

Other biasUnclear riskNo details about duration of study.

Blinding of participants and personnel (performance bias)
All outcomes
High riskNot mentioned.

Blinding of outcome assessment (detection bias)
All outcomes
Low riskDetailed reporting of outcome assessment.

Coco 2010

MethodsProspective randomised trial.


ParticipantsNulliparous women in spontaneous active labour with a singleton, vertex presentation ≥ 37 weeks' gestation were included. Women were eligible for inclusion if dilatation was between 2 and 5 cm, with or without ruptured membranes.

220 women were recruited.

116 women excluded due to preterm delivery, pre-eclampsia or scheduled CS.

11 women excluded as fluids were delayed.

4 women did not have consent forms.

9 women delivered elsewhere so were lost to follow-up.

80 women fulfilled criteria for inclusion and were analysed.


Interventions37 women received 250 mL of lactated Ringer’s solution IV per hour (IV fluid group) and 43 women received "usual care".

Usual care consisted of lactated Ringer’s solution IV for medical indications at the discretion of the provider. The women in this group received a mean volume of 1627 mL of fluid.

Both groups were allowed unrestricted oral intake of fluids.


OutcomesDuration of labour; first, second stage and total duration.


NotesUnrestricted oral fluids (water, juice, carbonated drinks) amounts recorded in both groups.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskRandom number chart.

Allocation concealment (selection bias)Low riskConsecutively numbered opaque sealed envelopes.

Incomplete outcome data (attrition bias)
All outcomes
High riskLarge attrition due to recruitment taking place antenatally rather than at the onset of labour.

Clear explanatory notes when attrition occurred.

220 women were recruited.

116 women excluded due to preterm delivery, pre-eclampsia or scheduled CS.

11 women excluded as fluids were delayed.

4 women did not have consent forms.

9 women delivered elsewhere so were lost to follow-up.

80 women fulfilled criteria for inclusion and were analysed.

Selective reporting (reporting bias)Low riskProspective data capture.

Other biasUnclear riskNo restriction on oral fluid intake may have influenced results; inherent bias of women drinking as much as possible, although similar mean oral intake in both groups.

Women recruited from 4 hospitals including 3 private practices.

Blinding of participants and personnel (performance bias)
All outcomes
High riskUnclear as to whether measures were taken to blind personnel.

Participants: potential bias in that they were informed about increased fluids in labour and allowed to drink.

Potential bias as participants recruited antenatally and could have influenced the amount of fluids ingested orally.

Blinding of outcome assessment (detection bias)
All outcomes
Low riskProspective analysis by nursing staff.

Direkvand-Moghadam 2012

MethodsProspective randomised controlled trial. 4 arms with individual randomisation.


Participants120 women in labour at a hospital in Ilam, Iran in 2010.

Inclusion criteria: nulliparity, aged between 18-35 years, singleton pregnancy, spontaneous active labour (defined as cervical dilatation of 4 to 5 cm), gestational age 38-40 weeks, normal fetal heart tracings, intact membranes and vertex presentation. Labour analgesia was not used.

Exclusion criteria: elective labour induction, emergency CS, known cephalopelvic disproportion, diagnosed pre-eclampsia, chorioamnionitis, pyelonephritis, maternal cardiac or renal disease, IUGR, cervix dilated > 5 cm.


Interventions4 groups: 30 women in each group

  1. Control. Free oral fluids (no IV fluids).
  2. Free oral fluids + IV Ringer lactate solution at infusion rate of 60 mL/hour.
  3. Free oral fluids + IV Ringer lactate solution at infusion rate of 120 mL/hour.
  4. Free oral fluids + IV Ringer lactate solution at infusion rate of 60 mL/hour.


In all groups partograms were used to monitor progress in labour. Amniotomy was performed by a midwife when cervical dilatation reached 5 cm if membranes had not ruptured spontaneously. At one hour after amniotomy, if uterine contractions were less than 3 in ten minutes, or dilation was less than 1.2 cm per hour, oxytocin was used for labour augmentation.


OutcomesDuration of active phase of first stage of labour, duration of 2nd and 3rd stages of labour, need for oxytocin augmentation, mode of delivery, Apgar scores at 1 and 5 minutes.


NotesIn the data and analyses in this review for comparison 4 (IV fluids plus oral intake vs oral intake alone) we have combined results for the three groups receiving IV fluids to allow a single pair-wise comparison between women receiving IV fluids plus oral fluids vs oral fluids alone. This study is also included in comparison 5 where different hourly rates of infusion are compared.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskRandom number tables.

Allocation concealment (selection bias)Low riskOpaque, sealed, consecutively numbered envelopes.

Incomplete outcome data (attrition bias)
All outcomes
Low risk120 women were randomised and all seemed to be accounted for in the analysis. There was no mention of missing data for any outcome.

Selective reporting (reporting bias)Unclear riskAssessment from published study report.

Other biasUnclear riskIn the methods section it was stated that the 4 groups were “matched” for inclusion criteria. It was not clear what this meant.

Blinding of participants and personnel (performance bias)
All outcomes
High riskBlinding women or staff to this intervention was not mentioned. Lack of blinding may have affected staff behaviour and outcome assessment.

Blinding of outcome assessment (detection bias)
All outcomes
High risk It was not mentioned whether any outcome data were collected by blind outcome assessors. Lack of blinding may have affected staff behaviour and outcome assessment.

Eslamian 2006

MethodsProspective double-blind randomised trial.


Participants300 nulliparous women enrolled; all women went in to spontaneous labour at term; singleton pregnancies; cephalic presentation.

153 randomised to 125 mL/hour; 147 women randomised to 250 mL/hour.


Interventions2 different volumes of Ringer's lactate solution (125 mL/hour vs 250 mL/hour).


OutcomesDuration of labour in minutes; CS due to failure to progress; assisted delivery.


NotesNil by mouth; no epidurals.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskRandom computer-generated numbers.

Allocation concealment (selection bias)Low riskConsecutively numbered opaque sealed envelopes.

Incomplete outcome data (attrition bias)
All outcomes
Low riskDetailed outcome data available for all 300 recruited women.

Selective reporting (reporting bias)Low riskNo evidence of selective reporting.

Other biasUnclear riskAuthors acknowledge the following: no measurements of inherent maternal dehydration; no measurements of skin turgor, osmolality.

Blinding of participants and personnel (performance bias)
All outcomes
Low riskDouble-blinded study with clear evidence of double-blinding measures.

Blinding of outcome assessment (detection bias)
All outcomes
Low riskNone apparent.

Garite 2000

MethodsProspective randomised trial.


Participants195 nulliparous women in term spontaneous labour with a singleton pregnancy, cephalic presentation.


Interventions125 mL/hour vs 250 mL/hour of Ringer's lactate solution.

94 women received 125 mL/hour while 101 women received the higher volume of 250 mL/hour.


OutcomesMaternal: duration of labour in minutes

Maternal/fetal: need for CS or assisted delivery/Apgar < 7; admission to SCBU.


NotesNo food; no oral fluid intake; sips of water only; ice chips allowed.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskRandom computer-generated sequence.

Allocation concealment (selection bias)Low riskConsecutively numbered opaque sealed envelopes.

Incomplete outcome data (attrition bias)
All outcomes
Low riskNone of the women randomised needed to be excluded.

Selective reporting (reporting bias)Low riskNone apparent.

Other biasUnclear riskNo measurement of inherent maternal dehydration; no assessment of serum/urine osmolality.

Blinding of participants and personnel (performance bias)
All outcomes
High riskNo masking of interventions.

Blinding of outcome assessment (detection bias)
All outcomes
Low riskNone apparent.

Kavitha 2012

MethodsRandomised controlled trial.


Participants293 nulliparous women with term spontaneous labours between 3- 6 cm dilatation, singleton pregnancy, cephalic presentation.


Interventions99 women received oral hydration.

98 women were randomised to receive 125 mL/hour of Ringer's lactate and oral fluids.

96 women were randomised to receiving 250 mL/hour of Ringer's lactate and oral fluids.


OutcomesMaternal: duration of labour, mode of delivery, CS delivery for failure to progress, vomiting.

Fetal: admission to NICU.


NotesOral fluids was allowed in all study groups (no quantification of volumes required).


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskComputerised block randomisation.

Allocation concealment (selection bias)Low riskSequential opaque envelopes.

Incomplete outcome data (attrition bias)
All outcomes
Low riskComplete outcomes for all participants; no attrition.

Selective reporting (reporting bias)Low riskNone apparent.

Other biasHigh riskWomen in control group (oral fluids) were allowed either plain fluids or coconut water (no clear discussion about possible bias with coconut water).

In IV fluid groups, maximum quantity of IV fluids was restricted to 3 litres "to prevent fluid overload".

Blinding of participants and personnel (performance bias)
All outcomes
High riskNo masking of interventions.

Blinding of outcome assessment (detection bias)
All outcomes
Low riskNone apparent.

Maderia 2007

MethodsProspective randomised trial.


Participants59 nulliparous women in term spontaneous labours with a singleton pregnancy, cephalic presentation.

30 women received 125 mL/hour; 29 women received 250 mL/hour.


Interventions125 mL/hour vs 250 mL/hour of unspecified IV fluid.


OutcomesDuration of labour in minutes; CS due to failure to progress.


NotesNil by mouth; only ice-chips.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Unclear riskNo information (abstract only).

Allocation concealment (selection bias)High riskNo information (abstract only); does not specify what type of IV fluid administered.

Incomplete outcome data (attrition bias)
All outcomes
Unclear riskNo information (abstract only).

Selective reporting (reporting bias)Unclear riskNo information (abstract only).

Other biasUnclear riskNo information (abstract only).

Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskNo information (abstract only).

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskNo information (abstract only).

Shrivastava 2009

MethodsProspective double-blinded randomised controlled trial.


Participants300 nulliparous women in term spontaneous labour with a singleton pregnancy, cephalic presentation enrolled.

5 women were withdrawn by their physician.

3 women did not meet inclusion criteria.

3 women had incomplete data collection.

11 women were not included in data analysis.

2 women were excluded (1 with diabetes mellitus 1 who developed pre-eclampsia).

289 women completed the study.


Interventions3 different groups:
97 women randomised to receive normal saline 125 mL/hour.

94 women randomised to receive 5% dextrose 125 mL/hour.

98 women randomised to receive 10% dextrose 125 mL/hour.


OutcomesMaternal: duration of first, second stages of labour and total duration of labour, CS.

Fetal/neonatal: admission to neonatal unit, Apgar scores < 7 at 5 minutes, hyperbilirubinaemia requiring therapy, cord pH < 7.20, arterial cord glucose, hypoglycaemia at 1 and 2 hours.


NotesNil by mouth; ice chips only.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskComputer-generated randomisation.

Allocation concealment (selection bias)Low riskConsecutively numbered opaque sealed envelopes by pharmacy staff.

Incomplete outcome data (attrition bias)
All outcomes
Low riskClear documentation of excluded women when incomplete data collection and clear documentation of reasons for attrition:

300 nulliparous women in term spontaneous labours with a singleton pregnancy, cephalic presentation enrolled.

5 women were withdrawn by their physician.

3 women did not meet inclusion criteria (1 with diabetes mellitus, 1 who developed pre-eclampsia and 1 woman < 18 years).

3 women had incomplete data collection.

11 women were not included in data analysis.

289 women completed the study.

Selective reporting (reporting bias)Low riskClear flow-diagrams and different tables for maternal and neonatal outcomes.

Other biasUnclear riskInsufficiently powered for neonatal outcomes.

Blinding of participants and personnel (performance bias)
All outcomes
Low riskDouble-blinded study; blinding by pharmacy personnel; each group assigned A, B, C and changed after every 80 women to minimise observer bias; IV bags were covered with non-transparent adhesive tapes to ensure double-blinding.

Blinding of outcome assessment (detection bias)
All outcomes
Low riskAdequate measures as above to ensure double-blinding.

Stratton 1995

MethodsProspective randomised trial.


Participants100 primigravid women in spontaneous labour.

7 women randomised but no blood taken so excluded from analysis.

4 other women declined consent.

2 other women excluded as no consent obtained by medical staff.


Interventions5% dextrose vs normal saline for oxytocin augmentation.


OutcomesMaternal : delivery outcomes, mean duration of labour, CS, maternal hyponatraemia, fluid overload.

Fetal: neonatal hyponatraemia. admission to NICU.


NotesSubgroup of women with epidurals.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskRandom allocation.

Allocation concealment (selection bias)Low riskSealed envelopes.

Incomplete outcome data (attrition bias)
All outcomes
Low riskClear explanations for attrition due to omission of obtaining blood samples; failure to obtain consent.

Selective reporting (reporting bias)Low riskDetailed explanations for all outcomes.

Other biasHigh riskA subgroup of women were given additional fluids as part of their epidurals.

Blinding of participants and personnel (performance bias)
All outcomes
Unclear riskNot clearly apparent that study was double-blind.

Blinding of outcome assessment (detection bias)
All outcomes
Unclear riskOutcomes not blinded.

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Boylan 1980Open and double-blind study.

Participants: unclear whether nullips or multips; also in a subgroup, labour was induced.

Interventions: intravenous bolus of glucose versus Hartmann's.

Outcome: fetal breathing; no maternal outcomes.

Caspi 1979Method: appears to be a case-controlled study.

There is no evidence that women were randomly assigned to the 2 groups.

Participants: 22 primips.

Intervention: sodium bicarbonate infusion.

Cerri 2000Participants: 81 women but no distinction between nullips and multips.

Intervention: 43 women received 5% glucose and 38 women did not receive any fluids.

Cheek 1996Prospective randomised controlled trial.

Participants: 34 labouring women (no clear distinction in outcomes between nullips and multips).

Interventions: extradural normal saline and glucose.

Fisher 1997Abstract only, so limited information.

Participants: multips and nullips.

Haesslein 1975Participants: all low-risk labouring women (nullips and multips).

Interventions: 5% dextrose in water versus 5% dextrose in saline.

Outcome: maternal hypertension.

Higgins 1996Randomised controlled trial.

Interventions; oxytocin in Hartmann's solution compared with the standard 5% dextrose regimen for induction or augmentation in labour.

Outcomes: maternal serum sodium.

Good study with clear randomisation method; reason for exclusion was non-spontaneous labour.

Hofmann 2001Participants: labouring women in their first or second pregnancy (no distinction between nullips and multips).

Interventions: glucose was compared with a glucose substitute treatment (Xylit) and an electrolyte treatment (Sterofundin).

Jamal 2007Randomised controlled trial.

Participants: 178 women but all were multiparous (at least para 1).

Intervention: 120 mL/hour of 5% dextrose was compared with the same volume of Ringer's lactate.

Outcomes: primary outcome was fetal acid-base status.

Kenepp 1985Randomised trial.

Participants: 31 term labourers; unclear whether nullips or multips or both.

Intervention: different concentrations of dextrose solutions.

Outcomes; ketoacidosis.

Limited information about duration of labour and other outcomes as published as abstract only.

Loong 1987Prospective randomised trial.

Participants: 48 women (nullips and multips).

Interventions: 5% dextrose solution or Hartmann's solution.

Outcomes: maternal and cord blood glucose.

Reason for exclusion: although there was a distinction between nullips and multips in the demographics, there was no distinction in the outcomes in terms of parity.

Menigaux 1993Randomised controlled trial.

Participants: 20 labouring women having epidurals (study does not specify whether nullips or multips).

Interventions: 50% dextrose versus Ringer's lactate in women who were given a basal infusion of 100 mL/hour Ringer's lactate before an epidural.

Outcome: maternal and neonatal hypoglycaemia.

Abstract only.

Navarette,1982Randomised controlled trial.

Participants: insufficient information on parity.

Outcome: intrapartum metabolic control.

Nordstrom 1995All participants were on average para 1 therefore excluded.

Omigbodun 1989Participants: all women who required oxytocin for induction of labour or augmentation (so non-spontaneous labours). Furthermore, no distinction regarding parity.

Intervention: normal saline or 5% glucose with oxytocin.

Outcomes: maternal postpartum blood pressure.

Omigbodun 1991Participants: all women who required oxytocin for induction of labour or augmentation (so non-spontaneous labours). Furthermore, no distinction regarding parity.

Intervention: normal saline or 5% glucose with oxytocin.

Outcomes: maternal postpartum sodium levels; cord sodium levels.

Omigbodun 1993Interventions: all women received oxytocin.

Oral 2003Participants: nullips and multips included; control group comprised entirely of multiparous women.

Interventions: oxytocin for augmentation.

Outcomes: neonatal bilirubin levels.

Rooth 1967Limited information available, published as abstract only.

Participants: 60 labouring women; unclear whether nulliparous or not; no details of randomisation.

Interventions: sodium bicarbonate given to half the participants.

Rosenberg 2006Participants: all women in this study were insulin requiring gestational diabetics therefore excluded.

Simpson 2005Participants: 42 women were randomised to either a 500 mL or 1000 mL intravenous fluid bolus over 20 minutes. All women were either being induced or having this bolus as a preload for epidurals.
51 women were randomised to 1 of 6 position sequences including supine with the head elevated 30°, left lateral and right lateral for 15 minutes each in succession.

Singhi 1982Study published as part of Letter-to-the Editor.

Participants: no mention of parity; so difficult to interpret results.

Thaler 2007Participants: 85 women; unclear whether nullips or multips.

Interventions: 10% glucose versus Ringer's lactate.

Abstract only; limited information.

Watson 2012Randomised controlled trial.

Participants: nulliparous or multiparous women requesting epidurals and who intended to breastfeed.

Interventions: different volumes of epidural preload.

Outcome measures: effect on weight loss on the newborn.

Wells-Brooks 2001Methods: quasi-experimental research design.

Participants: labouring women receiving combined spinal epidural anaesthesia.

Interventions: different volumes of intravenous fluids in women receiving combined spinal epidural anaesthesia.

Outcome measures: frequency of uterine contractions.

Wright 2000Prospective randomised double-blind study.

Participants: 32 insulin requiring diabetic women randomised to 2 different dextrose infusions.

 
Characteristics of studies awaiting assessment [ordered by study ID]
Amir 2004

MethodsThis study was identified by the search, but we have not yet been able to locate a copy of the paper.

Participants

Interventions

Outcomes

Notes

Rad 2012

MethodsDescribed as a "randomized clinical trial".

Participants97 primiparous women.

InterventionsGroup 1. IV normal saline 120 mL/minute.

Group 2. IV dextrose 5% in normal saline 120 mL/minute.

OutcomesCervical dilatation, duration of 2nd stage of labour, need for oxytocin, caesarean section, Apgar score at 1 and 5 minutes, neonatal hypoxia.

NotesThis study was reported in a paper published in Iranian. We are awaiting full translation in order to assess risk of bias and to carry out data extraction. (Brief abstract in English.)

 
Characteristics of ongoing studies [ordered by study ID]
Salim 2011

Trial name or titleIntrapartum Hydration

MethodsRandomised controlled trial.

ParticipantsNulliparous women in spontaneous labour; singleton pregnancy, gestational age 37-41 weeks.

InterventionsIntravenous fluids: 0.9 % saline with 5% glucose solution at rate of 125 mL/hour versus 250 mL/hour Ringer's lactate.

Outcomes
  • Duration of labour
  • Mode of delivery

Starting dateNovember 2010.

Contact informationRaed Salim

salim ra @clalit.org.il

NotesStatus of study: still recruiting.

 
Comparison 1. Intravenous fluids versus no fluids (restricted oral intake)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

1 Mean duration of labour in minutes00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

2 Caesarean section00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

3 Assisted delivery00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

4 Maternal hyponatraemia (sodium level < 135 mmol/L)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

5 Fluid overload00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

6 Subjective feelings of thirst00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

7 Maternal comfort/satisfaction00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

8 Admission to neonatal unit00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

9 Low Apgar scores (< 7 at 5 mins)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

10 Cord pH < 7.000Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

11 Neonatal hyponatraemia (cord sodium level < 135 mmol/L)00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

12 Neonatal hypoglycaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

13 Fetal hyperbilirubinaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

14 Newborn weight loss( first 72 hours)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 2. Intravenous fluids alone versus no intravenous fluids (unrestricted oral intake

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

1 Mean duration of labour00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

2 Caesarean section00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

3 Assisted delivery00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

4 Fluid overload or pulmonary oedema00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

5 Maternal hyponatraemia (sodium level < 135 mmol/L)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

6 Subjective feelings of thirst00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

7 Maternal comfort/satisfaction00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

8 Admission to neonatal unit00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

9 Low Apgar scores (< 7 at 5 mins)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

10 Cord pH < 7.000Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

11 Neonatal hyponatraemia (cord sodium level < 135 mmol/L)00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

12 Neonatal hypoglycaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

13 Fetal hyperbilirubinaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

14 Newborn weight loss( first 72 hours)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 3. Intravenous fluids alone versus intravenous fluids and oral intake

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

1 Mean duration of labour in minutes00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

2 Caesarean section00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

3 Assisted delivery00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

4 Maternal hyponatraemia (sodium level < 135 mmol/L)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

5 Fluid overload00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

6 Subjective feelings of thirst00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

7 Maternal comfort/satisfaction00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

8 Admission to neonatal unit00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

9 Low Apgar scores (< 7 at 5 mins)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

10 Cord pH < 7.000Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

11 Neonatal hyponatraemia (cord sodium level < 135 mmol/L)00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

12 Neonatal hypoglycaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

13 Fetal hyperbilirubinaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

14 Newborn weight loss (first 72 hours)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 4. Intravenous fluids + oral intake versus oral intake alone

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Mean duration of labour2241Mean Difference (IV, Fixed, 95% CI)-28.86 [-47.41, -10.30]

 2 Caesarean section2315Risk Ratio (M-H, Fixed, 95% CI)0.73 [0.49, 1.08]

3 Assisted delivery00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 4 Fluid overload1195Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 5 Admission to neonatal unit1195Risk Ratio (M-H, Fixed, 95% CI)0.52 [0.05, 5.59]

 6 Low Apgar scores (< 7 at 5 mins)1120Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

7 Cord pH < 7.000Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

8 Newborn weight loss (first 72 hours)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

9 Maternal hyponatraemia (sodium level < 135 mmol/L)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

10 Subjective feelings of thirst00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

11 Maternal comfort/satisfaction00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

12 Neonatal hyponatraemia (cord sodium level < 135 mmol/L)00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

13 Neonatal hypoglycaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

14 Fetal hyperbilirubinaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 5. 125 mL/hour intravenous fluids + oral intake versus 250 mL/hour intravenous fluids + oral intake

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Mean duration of labour in minutes3256Mean Difference (IV, Fixed, 95% CI)23.87 [3.72, 44.02]

 2 Caesarean section3334Risk Ratio (M-H, Random, 95% CI)1.00 [0.54, 1.87]

 3 Assisted delivery180Risk Ratio (M-H, Fixed, 95% CI)0.47 [0.27, 0.81]

 4 Fluid overload2274Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 5 Admission to neonatal unit2274Risk Ratio (M-H, Fixed, 95% CI)0.56 [0.15, 2.06]

 6 Low Apgar scores (< 7 at 5 mins)2140Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

7 Cord pH < 7.000Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

8 Newborn weight loss (first 72 hours)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

9 Maternal hyponatraemia (sodium level < 135 mmol/L)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

10 Subjective feelings of thirst00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

11 Maternal comfort/satisfaction00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

12 Neonatal hyponatraemia (cord sodium level < 135 mmol/L)00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

13 Neonatal hypoglycaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

14 Fetal hyperbilirubinaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 6. 125 mL/hour fluids versus 250 mL/hour fluids (restricted oral intake in both arms)

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Mean duration of labour in minutes4632Mean Difference (IV, Random, 95% CI)105.61 [53.19, 158.02]

 2 Caesarean section4748Risk Ratio (M-H, Fixed, 95% CI)1.56 [1.10, 2.21]

 3 Assisted delivery2495Risk Ratio (M-H, Fixed, 95% CI)0.78 [0.44, 1.40]

 4 Fluid overload1195Risk Ratio (M-H, Fixed, 95% CI)3.22 [0.13, 78.11]

 5 Admission to neonatal unit3689Risk Ratio (M-H, Random, 95% CI)0.48 [0.07, 3.17]

 6 Low Apgar scores (< 7 at 5 mins)3689Risk Ratio (M-H, Fixed, 95% CI)4.35 [0.97, 19.51]

7 Cord pH < 7.000Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

8 Newborn weight loss (first 72 hours)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

9 Maternal hyponatraemia (sodium level < 135 mmol/L)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

10 Subjective feelings of thirst00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

11 Maternal comfort/satisfaction00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

12 Neonatal hyponatraemia (cord sodium level < 135 mmol/L)00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

13 Neonatal hypoglycaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

14 Fetal hyperbilirubinaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 7. 125 mL/hour Ringer's lactate versus 125 mL/hour versus 5% dextrose

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

1 Mean duration of labour in minutes00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

2 Caesarean section00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

3 Assisted delivery00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

4 Fluid overload00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

5 Admission to neonatal unit00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

6 Low Apgar scores (< 7 at 5 mins)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

7 Cord pH < 7.000Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

8 Newborn weight loss (first 72 hours)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

9 Maternal hyponatraemia (sodium level < 135 mmol/L)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

10 Subjective feelings of thirst00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

11 Maternal comfort/satisfaction00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

12 Neonatal hyponatraemia (cord sodium level < 135 mmol/L)00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

13 Neonatal hypoglycaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

14 Fetal hyperbilirubinaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 
Comparison 8. Normal saline versus 5% dextrose solutions

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Mean duration of labour in minutes191Mean Difference (IV, Random, 95% CI)-12.0 [-30.09, 6.09]

 2 Caesarean section2284Risk Ratio (M-H, Fixed, 95% CI)0.77 [0.41, 1.43]

 3 Assisted delivery193Risk Ratio (M-H, Fixed, 95% CI)0.59 [0.21, 1.63]

 4 Fluid overload193Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 5 Admission to neonatal unit2284Risk Ratio (M-H, Fixed, 95% CI)1.11 [0.42, 2.93]

 6 Low Apgar scores (< 7 at 5 mins)2284Risk Ratio (M-H, Random, 95% CI)0.48 [0.04, 5.25]

7 Cord pH < 7.000Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

8 Newborn weight loss (first 72 hours)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 9 Maternal hyponatraemia (sodium level < 135 mmol/L)191Risk Ratio (M-H, Fixed, 95% CI)0.06 [0.00, 0.94]

10 Subjective feelings of thirst00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

11 Maternal comfort/satisfaction00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

 12 Neonatal hyponatraemia (cord sodium level < 135 mmol/L)193Risk Ratio (M-H, Fixed, 95% CI)0.4 [0.17, 0.93]

 13 Neonatal hyperbilirubinaemia1191Risk Ratio (M-H, Fixed, 95% CI)0.39 [0.08, 1.95]

 14 Neonatal hypoglycaemia (< 40 mg/dL)1191Risk Ratio (M-H, Fixed, 95% CI)0.97 [0.20, 4.68]

 
Comparison 9. 125 mL normal saline versus 125 mL Ringer's lactate

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

1 Mean duration of labour in minutes00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

2 Caesarean section00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

3 Assisted delivery00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

4 Maternal hyponatraemia (sodium level < 135 mmol/L)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

5 Fluid overload00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

6 Subjective feelings of thirst00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

7 Maternal comfort/satisfaction00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

8 Admission to neonatal unit00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

9 Low Apgar scores (< 7 at 5 mins)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

10 Cord pH < 7.000Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

11 Neonatal hyponatraemia (cord sodium level < 135 mmol/L)00Mean Difference (IV, Fixed, 95% CI)0.0 [0.0, 0.0]

12 Neonatal hypoglycaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

13 Fetal hyperbilirubinaemia00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]

14 Newborn weight loss (first 72 hours)00Risk Ratio (M-H, Fixed, 95% CI)0.0 [0.0, 0.0]