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Meta-Analysis
. 2013 Nov 4;2013(11):CD003096.
doi: 10.1002/14651858.CD003096.pub2.

Hydration for treatment of preterm labour

Catalin M Stan  1 , Michel Boulvain, Riccardo Pfister, Pascale Hirsbrunner-Almagbaly
Affiliations
Meta-Analysis

Hydration for treatment of preterm labour

Catalin M Stan et al. Cochrane Database Syst Rev. .

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 methods: 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.

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.

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Conflict of interest statement

None known.

Figures

1.5
1.5. Analysis
Comparison 1 Hydration versus no treatment/bed rest alone (all women), Outcome 5 Delivery before 37 weeks.
1.6
1.6. Analysis
Comparison 1 Hydration versus no treatment/bed rest alone (all women), Outcome 6 Delivery before 34 weeks.
1.7
1.7. Analysis
Comparison 1 Hydration versus no treatment/bed rest alone (all women), Outcome 7 Delivery before 32 weeks.
1.8
1.8. Analysis
Comparison 1 Hydration versus no treatment/bed rest alone (all women), Outcome 8 Admission to neonatal intensive care unit.
1.13
1.13. Analysis
Comparison 1 Hydration versus no treatment/bed rest alone (all women), Outcome 13 Cost of treament (first 24 hours, in US$).
1.14
1.14. Analysis
Comparison 1 Hydration versus no treatment/bed rest alone (all women), Outcome 14 Use of tocolytic drugs (not prespecified).
1.15
1.15. Analysis
Comparison 1 Hydration versus no treatment/bed rest alone (all women), Outcome 15 Time to delivery (days, not prespecified).
2.4
2.4. Analysis
Comparison 2 Hydration versus no treatment/bed rest alone (women included before 34 weeks), Outcome 4 Delivery before 34 weeks.
2.5
2.5. Analysis
Comparison 2 Hydration versus no treatment/bed rest alone (women included before 34 weeks), Outcome 5 Delivery before 37 weeks.
2.10
2.10. Analysis
Comparison 2 Hydration versus no treatment/bed rest alone (women included before 34 weeks), Outcome 10 Admission to neonatal intensive care unit.
2.13
2.13. Analysis
Comparison 2 Hydration versus no treatment/bed rest alone (women included before 34 weeks), Outcome 13 Cost of treament (first 24 hours, in US$).
2.14
2.14. Analysis
Comparison 2 Hydration versus no treatment/bed rest alone (women included before 34 weeks), Outcome 14 Use of tocolytic drugs (not prespecified).
2.15
2.15. Analysis
Comparison 2 Hydration versus no treatment/bed rest alone (women included before 34 weeks), Outcome 15 Time to delivery (days, not prespecified).
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