Hydration for treatment of preterm labour

Unless they are dehydrated, there seems to be no benefit from additional intravenous fluids for women in preterm labour.

Preterm birth (before 37 weeks) can cause health problems and be life-threatening for babies. As women in preterm labour often have lower amounts of fluid in their circulation, using an intravenous drip to increase the woman's blood volume is sometimes tried (hydration). It has been hoped that the extra fluid might somehow slow down contractions. However, from the limited information available (two studies involving 228 women), the review found that there is no evidence of a benefit in the use of hydration to help prevent preterm labour, although it may be helpful for women who are dehydrated.

Authors' conclusions: 

The data are too few to support the use of hydration as a specific treatment for women presenting with preterm labour. The two small studies available do not show any advantage of hydration compared with bed rest alone. Intravenous hydration does not seem to be beneficial, even during the period of evaluation soon after admission, in women with preterm labour. Women with evidence of dehydration may, however, benefit from the intervention.

Read the full abstract...
Background: 

Hydration has been proposed as a treatment for women with preterm labour. Theoretically, hydration may reduce uterine contractility by increasing uterine blood flow and by decreasing pituitary secretion of antidiuretic hormone and oxytocin.

Objectives: 

To evaluate the effectiveness of intravenous or oral hydration to avoid preterm birth and its consequences in women with preterm labour.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2013) and bibliographies of relevant papers.

Selection criteria: 

Randomised controlled trials, including women with a viable pregnancy less than 37 completed weeks' gestation and presenting with preterm labour, comparing intravenous or oral hydration with no treatment. The intervention might or might not be associated with bed rest. Studies comparing tocolytic drugs with intravenous fluids used in the control group as a placebo were not included in this review.

Data collection and analysis: 

Two review authors independently assessed the reports, to determine if the study met the inclusion criteria and to evaluate the methodological quality. Data were extracted independently by two of the review authors. The results were expressed as risk ratios (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes.

Main results: 

Two studies, including a total of 228 women with preterm labour and intact membranes, compared intravenous hydration with bed rest alone. Risk of preterm delivery, before 37 weeks (RR) 1.09; 95% confidence interval (CI) 0.71 to 1.68), before 34 weeks (RR 0.72; 95% CI 0.20 to 2.56) or before 32 weeks (RR 0.76; 95% CI 0.29 to 1.97), was similar between groups. Admission to neonatal intensive care unit occurred with similar frequency in both groups (RR 0.99; 95% CI 0.46 to 2.16). Cost of treatment was slightly higher (US$39) in the hydration group. This difference was not statistically significant and only includes hospital costs during a visit of less than 24 hours. No studies evaluated oral hydration.

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