Vineet Shrivastava

A randomized, double-blinded, controlled trial comparing parenteral normal saline with and without dextrose on the course of labor in nulliparas

OBJECTIVE The objective of the study was to compare intravenous normal saline with and without dextrose on the course of labor in nulliparae. STUDY DESIGN In a double-blinded, controlled trial, term, nulliparae with singletons in active labor were randomized into 1 of 3 groups receiving either normal saline (NS), NS with 5% dextrose (D5NS), or NS with 10% dextrose (D10NS) at 125 mL/h. The primary outcome was total length of labor from onset of study fluid in vaginally delivered subjects. Maternal and neonatal outcomes were also analyzed. RESULTS Of 300 subjects enrolled, 289 met inclusion criteria and completed the study. In vaginally delivered subjects, significant differences were noted in the second stage (P = .01) and total length of labor (P = .02). No significant differences were observed in the cesarean section rates between the groups (P = .21). No differences were noted in maternal or neonatal secondary outcomes. CONCLUSION Administration of a dextrose solution, regardless of concentration, was associated with a shortened labor course in term vaginally delivered nulliparae subjects in active labor.

Patient-prosthesis mismatch in pregnancy.

BACKGROUND: Patient–prosthesis mismatch is a known and severe complication after aortic valve repair in the general population. There is a paucity of literature regarding this condition in pregnancy. CASE: We present the clinical course of a pregnant woman with severe patient–prosthesis mismatch after aortic valve replacement. After extensive workup, the patient underwent aortic valve replacement, enlargement of the aortic root, and placement of a larger prosthetic valve at 21 weeks of gestation. Her postoperative course was complicated by fetal death. CONCLUSION: Cardiopulmonary bypass and aortic valve replacement present a multitude of risks to maternal and fetal health. The obstetrician managing pregnant women with prosthetic heart valves should be aware of the complications that may arise, including patient–prosthesis mismatch.

Dextrose intravenous fluid therapy in labor reduces the length of the first stage of labor

The aim of this systematic review with meta-analysis was to evaluate the effect on length of labor when patients receive IVF with or without dextrose. Searches were performed in electronic databases from inception of each database to May 2018. Trials comparing intrapartum IVF containing dextrose (i.e. intervention group) with no dextrose or placebo (i.e. control group) were included. Only trials examining low-risk pregnancies in labor at ≥36 weeks were included. Studies were included regardless of oral intake restriction. The primary outcome was the length of total labor from randomization to delivery. The meta-analysis was performed using the random effects model. Sixteen trials (n = 2503 participants) were included in the meta-analysis. Women randomized in the IVF dextrose group did not have a statistically significant different length of total labor from randomization to delivery compared to IVF without dextrose (MD -38.33 min, 95% CI -88.23 to 11.57). IVF with dextrose decreased the length of the first stage (MD -75.81 min, 95% CI -120.67 to -30.95), but there was no change in the second stage. In summary, use of IVF with dextrose during labor in low-risk women at term does not affect total length of labor, but it does shorten the first stage of labor.

Successful pregnancy in a patient with severe combined immunodeficiency syndrome treated with bone marrow transplantation.

BACKGROUND: We present the case of a patient with a history of severe combined immunodeficiency (SCID) syndrome successfully treated with bone marrow transplantation. Her resultant Rh alloimmunization complicated her first pregnancy. CASE: The patient was diagnosed with SCID syndrome after a series of opportunistic infections. The patient underwent bone marrow transplantation, receiving the graft from her haploidentical father. Once pregnant, her antepartum course was complicated by Rh alloimmunization resulting from her bone marrow transplantation, changing her blood antigen status from D-positive to D-negative. Antenatally, she was closely managed with serial middle cerebral artery Doppler measurements and delivered a healthy baby girl at term. CONCLUSION: Bone marrow transplantation in a patient with SCID syndrome resulted in Rh isoimmunization, complicating pregnancy management.