A randomized controlled trial of a new treatment for labor dystocia

Abstract

Objective: Labor dystocia is an intransigent, high-profile issue in obstetric care. Amniotic fluid lactate (AFL) reflects the uterine metabolic status. High levels associate with subsequent need for operative intervention due to dystocia. In sports medicine, it is known that lactic acid can affect muscular performance and can be decreased by bicarbonate given orally before physical activity.

Material and methods: Two hundred dystocic deliveries were included. At the confirmation of dystocia, the AFL-level was analyzed. Deliveries were randomized to an intake of bicarbonate or not. In the “non-bicarbonate-group”, stimulation with oxytocin was started immediately. In the “bicarbonate-group”, bicarbonate was given; and oxytocin was started 1 hour after the intake. New sampling of AF was performed after 1 hour in both groups. Outcome measured: if an oral intake of bicarbonate changes the AFL levels and enhances delivery outcome in dystocic deliveries.

Results: Bicarbonate decreases the AFL levels (p < .001). The spontaneous vaginal delivery rate after treatment with bicarbonate was increased (p = .007), without affecting the fetal outcome.

Conclusions: An increase of spontaneous vaginal deliveries resulted from bicarbonate ingestion by dystocic women. A decreased level of AFL-level was shown. This simple, low cost treatment has the potential to improve maternal morbidity and satisfaction worldwide.

Keywords:

• AFL
• bicarbonate
• caesarean
• dystocia
• labor

Acknowledgements

We acknowledge all the women who consented to participate in this trial and the large number of midwife and assistant nurses at the delivery ward of Soder Sjukhuset, Stockholm, Sweden.

Disclosure statement

EWI received in early 2000 a smaller number of shares in a company (ObsteCare AB, Sweden) that may use the results of the study commercially in the future. Over the past ten years, none of the authors received any shares, equity, promise of employment, or a named position on a company board. None of the authors has been asked by any organization to write, be named in, or to submit the paper.

Additional information

Funding

The study was funded by ‘Enquist’s Memorial Fund (Sweden)’, ‘Johan and Jacob Söderberg Foundation (Sweden)’ and ‘Crown Princess Lovisa's Association for Child Care/Foundation Axel Tielmans Memorial Fund’. The sponsors had no role in the design of the analysis, interpretation of the results, or the decision to submit the manuscript for publication. The corresponding author had final responsibility for the decision to submit for publication.