PMC:2675008 / 6249-14532 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/2675008","sourcedb":"PMC","sourceid":"2675008","source_url":"https://www.ncbi.nlm.nih.gov/pmc/2675008","text":"Statistics\nWomen were recruited to permit the inclusion of at least 30 women in each of four groups composed according to duration of labour and obstetric outcome. In addition, 30 women delivered by planned caesarean section were included as controls. A mean decrease of the sodium concentration of 5 mmol/l during labour would be considered significant. The sample size of at least 26 women in each group was required for a 90% power to detect a significant difference with a two-sided alpha error of 0.05 (Table 1). Mothers or infants with missing data were excluded from the corresponding analysis only. Group differences were analysed using nonparametric tests for continuous parameters (Mann–Whitney U test when comparing two groups and Kruskal–Wallis analysis of variance when more than two groups were compared). Spearman's rank correlation was used for association between two variables. Categorical variables were compared with chi-square test if the number of subjects was appropriate, otherwise Fisher's exact test was used. Initial analysis of the results indicated that major clarity of the presentation could be achieved by reallocating the study participants to three new groups composed according to total fluid administration during labour (Table 2).\nTable 1 Baseline values and observed changes related to fluids given until birth. Group differences analysed using Kruskal–Wallis nonparametric ANOVA and Mann–Whitney U test\nControl group elective caesarean (n = 26) Total fluids given until birth Kruskal–Wallis P value Mann–Whitney P value\nFluid group 1 \u003c1000 ml (n = 113) Fluid group 2 1000–2500 ml (n = 87) Fluid group 3 \u003e2500 ml (n = 61)\nMedian Q1–Q3 Median Q1–Q3 Median Q1–Q3 Median Q1–Q3\nMother\nAge 32 27–35 31 28–34 30 27–33 30 26–33 0.117\nWeight before pregnancy (kg) 67 58–78 66 59–73 67 60–77 66 60–77 0.750\nBody mass index before pregnancy 26.2 22.6–28.1 23.7 21.0–25.5 24.1 21.5–27.9 23.9 22.1–27.1 0.066\nWeight at term (kg) 83 72–89 79 71–89 80 74–90 83 74–91 0.399\nWeight increase 12 10–18 13 11–16 14 10–17 15 11–19 0.466\nGestational weeks 38.5 38.3–38.7 39.7 39.0–40.6 40.0 39.1–40.9 40.3 39.6–41.0 0.087\nCervical dilatation at admission (cm) — — 5.0 4.0–7.0 4.0 3.0–4.0 3.0 2.0–4.0 \u003c0.001 \u003c0.001\nDuration of labour (hours) — — 1.6 0.9–3.0 5.9 4.3–8.9 12.2 9.8–14.7 \u003c0.001 \u003c0.001\nDuration second stage (hours) — — 0.2 0.1–0.5 0.5 0.2–1.0 0.6 0.4–1.0 \u003c0.001 \u003c0.001\nOral fluids (ml/hour) 0 0–0 185 79–316 196 136–305 196 154–263 0.429\nIntravenous fluid (ml/hour) Not measured Not measured 0 0–0 52 3–102 94 53–144 \u003c0.001 \u003c0.001\nTotal fluid (ml/hour) Not measured Not measured 194 100–325 291 201–362 314 260–360 \u003c0.001 \u003c0.001\nTotal fluid (ml) Not measured Not measured 400 200–575 1680 1355–2050 3570 2925–4355 —\nOxytocin (ml) — — 0 0–0 50 0–166 200 100–400 \u003c0.001 \u003c0.001\nOxytocin (units) — — 0.0 0.0–0.0 1.0 0.0–3.3 4.0 2.0–8.0 \u003c0.001 \u003c0.001\nOxytocin (maximum rate mU/minute)* — — 10 5–20 20 10–30 40 20–60 \u003c0.001 \u003c0.001\nDuration epidural (hours) — — 1.7 1.7–1.7 4.3 2.9–6.1 8.8 6.8–10.6 —\nOsmolality at baseline (mOsm/kg) 279 277–281 280 277–282 280 276–282 279 277–281 0.501\nOsmolality postpartum (mOsm/kg) 280 277–282 282 279–284 277 276–281 274 272–277 \u003c0.001 \u003c0.001**\nNa at baseline (mmol/l) 137 136–138 137 136–137 136 135–137 136 135–138 0.238\nNa postpartum (mmol/l) 137 137–138 136 135–137 135 133–136 133 130–135 \u003c0.001 \u003c0.001**\nNa change (mmol/l) 0.0 −1.0 to 1.0 0.0 −1.0 to 1.0 −2.0 −3.0 to −1.0 −3.0 −5.0 to −1.0 \u003c0.001 \u003c0.001**\nGlucose at baseline (mmol/l) 5.0 4.5–5.5 5.1 4.7–5.8 5.2 4.9–5.9 5.3 4.8–6.2 0.133\nGlucose postpartum (mmol/l) 4.8 4.2–5.1 6.7 5.9–7.9 7.7 6.5–9.4 7.8 6.9–9.4 \u003c0.001 \u003c0.001**\nUmbilical cord\nArterial BE −2.0 −3.0 to −1.0 −4.0 −6.0 to −3.0 −5.0 −7.0 to −3.0 −6.0 −9.0 to −3.0 \u003c0.001 0.006**\nArterial pH 7.27 7.24–7.29 7.26 7.22–7.31 7.24 7.19–7.29 7.24 7.17–7.29 0.042 0.014***\nArterial Na (mmol/l) 139 138–140 139 137–140 137 136–139 136 134–138 \u003c0.001 \u003c0.001**\nArterial–venous Na difference (mmol/l) 1.0 0.0–1.0 1.0 0.0–2.0 1.0 0.0–2.0 1.0 0.0–2.0 0.736\nArterial glucose (mmol/l) 3.4 3.0–3.7 4.2 3.6–5.0 5.2 4.2–6.1 5.4 4.7–6.6 \u003c0.001 \u003c0.001**\nInfant\nBirthweight (g) 3415 3120–3790 3535 3305–3850 3670 3360–4160 3805 3580–4040 0.001 0.001**\nAll group differences are compared with Kruskal–Wallis nonparametric analysis of variance (ANOVA). When significant differences are found, Mann–Whitney U test is performed to analyse differences between fluid groups 1 and 3.\n* Including only subjects who received oxytocin. Maximum rate mU/minute: maximum rate of oxytocin infusion during first stage of labour.\n** Differences between control group elective caesarean and fluid group 3: P \u003c 0.001 (Mann–Whitney) (additional significant test).\n*** Difference between control group elective caesarean and fluid group 3: P = 0.14 (Mann–Whitney) (additional significant test).\nTable 2 Baseline values and total fluids (oral plus intravenous) given until birth\nControl group elective caesarean (n = 26) n(%) Total fluids given until birth Chi-square P value Fischer P value\nFluid group 1 \u003c1000 ml (n = 113) n(%) Fluid group 2 1000–2500 ml (n = 87) n(%) Fluid group 3 \u003e2500 ml (n = 61) n(%)\nInitial groups*\nVaginal \u003c4 hours — 88 (78) 20 (23) 1 (2)\nVaginal \u003e4 hours, no epidural — 13 (12) 34 (39) 6 (10)\nVaginal \u003e4 hours with epidural — 0 (0) 30 (34) 40 (66)\nEmergency caesarean section — 12 (11) 3 (3) 14 (23)\nElective caesarean section 26 (100) 0 (0) 0 (0) 0 (0)\nParity\nNullipara 12 (46) 23 (20) 44 (51) 46 (75)\nMultipara 14 (54) 90 (80) 43 (49) 15 (25) \u003c0.001 \u003c0.001\nComplications\nGestational diabetes 0 (0) 0 (0) 3 (3) 0 (0)\nPre-eclampsia 0 (0) 3 (3) 0 (0) 5 (8)\nHypertension 0 (0) 5 (4) 1 (1) 1 (2)\nOnset of labour\nNone 26 (100) 5 (4) 0 (0) 0 (0)\nInduction — 8 (7) 7 (8) 8 (13)\nSpontaneous — 100 (88) 80 (92) 53 (87) 0.455**\nDelivery\nVaginal, spontaneous — 98 (87) 71 (82) 37 (61) 0.001*** 0.001\nVaginal, instrumental*** — 3 (3) 13 (15) 10 (16)\nCaesarean section 26 (100) 12 (11) 3 (3) 14 (23)\nIndication for caesarean section\nBreech 17 (65) 6 (5) 0 (0) 0 (0)\nPrevious uterine operation 7 (27) 0 (0) 0 (0) 0 (0)\nFetal asphyxia — 1 (1) 1 (1) 1 (2)\nFailure to progress — 2 (2) 2 (2) 12 (20)\nOthers 2 (8) 3 (3) 0 (0) 1 (2)\nAnalgesia\nEpidural**** — 1 (1) 36 (41) 52 (85)\nSpinal — 1 (1) 3 (3) 0 (0)\nOxytocin\nYes — 14 (12) 57 (66) 59 (97) \u003c0.001 \u003c0.001\n≥5 units — 1 (1) 12 (14) 27 (44) 0.012*****\nMaternal p-Na\n≤130 mmol/l 0 (0) 1 (1) 4 (5) 16 (26) \u003c0.001 0.001\nMaternal p-glucose\n\u003e12 mmol/l 0 (0) 2 (2) 2 (2) 7 (11) 0.013 0.009\nInfant\nApgar \u003c7 at 1 minute 0 (0) 4 (4) 5 (6) 5 (8) 0.219\nApgar \u003c7 at 5 minutes 0 (0) 1 (1) 0 (0) 0 (0)\nWeight loss \u003e10% 1 (4) 2 (2) 3 (3) 5 (8) 0.050\nHypoglycaemia 2 (8) 4 (4) 3 (3) 2 (3) 1.00\nRespiratory problem 1 (4) 5 (4) 7 (8) 8 (13) 0.065\nGroup differences are compared with chi-square test. When significant differences are found or when cases are few, Fischer's exact test is performed to analyse differences between fluid groups 1 and 3.\n* Vaginal \u003c4 hours or \u003c4 hours: Vaginal delivery, labour of shorter or longer duration than 4 hours. Epidural: epidural or spinal analgesia.\n** Induction versus spontaneous onset of labour.\n*** Vaginal spontaneous delivery versus instrumental vaginal delivery plus delivery by emergency caesarean section.\n**** One woman received combined spinal-epidural analgesia during labour.\n***** Calculation only includes women who received oxytocin for augmentation of labour. Univariate and multivariate logistic regressions were performed to study the relationship between maternal hyponatraemia and parity, age, and body mass index as well as fluid volumes administered, epidural analgesia, and oxytocin during labour. All tests were two tailed, and a P value of \u003c0.05 was considered statistically significant. The software used was Statistica release 7.1 (Statistica; StatSoft®, Tulsa, OK, 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