Ketonuria during labour

Effect of maternal intrapartum glucose therapy on neonatal blood glucose levels and neurobehavioral status of hypoglycemic term newborn infants

“…Although there are clearly defined indications for glucose infusion during labor, yet the practice is not entirely safe for the newborn infant [8]. Besides causing an alteration in neonatal glucose homeostatis as shown by previous studies and our data, infusions of glucose solution for hydration or oxytocin therapy may also cause fetal and neonatal acidosis [14], transplacental neonatal hyponatremia [20,23] and an increased risk of neonatal jaundice [21] and respiratory distress [22].…”

Hydration in labor Is routine intravenous hydration necessary?

“…One of the earliest studies is from Germany, in 1939, which concluded that uterine activity was decreased by an accumulation of ketones 7 . Researchers have commented that there seems to be an association between marked ketonuria and prolonged labor, but it is not clear which is the cause and which the effect 8 . Does ketonuria prolong labor or does prolonged labor just happen to produce more ketones?…”

“…Fetal distress, when not due to hypotension, is not aided by the bolus of fluids 16 . Anesthetists administering epidural anesthesia need not hydrate the laboring woman with large volumes of 5% dextrose before the procedure 8,17 . When oxytocin augmentation/induction is used, Pitocin should not be added to D 5 W, but to Ringer's lactate.…”

Midwifery management of prodromal labor

“…Hydration is mentioned by all the midwives and although many obstetric units disagree with oral intake during labor, it seems there is evidence that oral intake may be the safest approach. A commentary in the British Journal of Obstetrics and Gynecology , 5 states that small amounts of ketones in the urine are normal during labor. The author of this commentary questions the wisdom of giving large amounts of intravenous solutions, especially those that are high in glucose and salt free.…”