Labor dystocia is an intransigent, high-profile issue in obstetric care, which causes significant maternal morbidity in low resource settings and maternal dissatisfaction, and increased healthcare costs worldwide. Amniotic fluid lactate, (AFL), values have recently been shown to reflect the metabolic status of the uterus and high levels have a strong association with subsequent need for operative intervention due to dystocia. In sports medicine, it is known that lactic acid can affect muscular performance but be decreased by bicarbonate given orally before physical activity. Main Outcome Measures: If an intake of bicarbonate, one hour before stimulation with oxytocin in cases with a high AFL value, changes the AFL levels and enhances delivery outcome in dystocic deliveries. Design: Randomized controlled trial
Primary question: whether high AFL values (\>12mmol/l) in women with observed dystocic labor are best treated by 1. to handle childbirth according to the clinic's current guidelines in case of labor dystocia, i.e. with oxytocin stimulation 2. an intake of bicarbonate (Samarin) dissolved in water given 1 hour before the oxytocin is started Primary outcome variable A comparison of the frequency of spontaneous vaginal delivery in the observed two described intervention groups.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
2,000
Half of the group with a high AFL value will have a glass of Samarin to drink
Eva Wiberg-Itzel
Stockholm, Sweden
Labor outcome
Labor outcome in the different groups (spontaneous vaginal, VE or caesarean section)
Time frame: through study completion, an average of 1 year
AFL values
AFL-values to be at different times during labor
Time frame: through study completion, an average of 1 year
The use of oxytocin
Oxytocin stimulation (number of hours of stimulation and amount of oxytocin given),
Time frame: through study completion, an average of 1 year
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