Interventions for ketosis during labour.
BACKGROUND
In labour, ketosis (the elevation of ketone bodies in the blood) is a common occurrence, due to increased physical stress, which is often compounded by reduced oral intake. The effect of ketosis on the mother and baby during labour is not clear, therefore, there is uncertainty as to whether ketosis is a normal physiological response or whether women with ketosis in labour require intervention (such as intravenous fluids or increased oral intake) for maternal and infant wellbeing. This uncertainty has resulted in differences in opinion and practice by those providing care for women in labour.


OBJECTIVE
To assess the effects on maternal, fetal and neonatal outcomes of intravenous fluids or increased oral intake administered to women in labour for the treatment of ketosis compared with no intervention (defined as no oral intake, ice chips only, or oral intake on demand) and to also assess the effects of different types of intravenous fluids administered.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008), CENTRAL (The Cochrane Library 2007, Issue 2), MEDLINE (1950 to January 2007), EMBASE (1988 to January 2007) and CINAHL (1982 to 2007).


METHODS
All published and unpublished randomised trials in which additional oral intake or intravenous fluids, or both, were used for the treatment of women with ketosis in labour.


METHODS
Two authors independently assessed potentially eligible trials. The authors sought additional information on trial methods and outcome data to enable consideration of eligibility of studies. However, at the time of the review, no information was received.


RESULTS
We identified six trials as potentially eligible for inclusion in this review. All six studies were excluded. Therefore no trials are included in this review.


CONCLUSIONS
There is no information on which to base practice in the treatment of women with ketosis during labour. Further research is required to identify more clearly the association between ketosis in labour and pregnancy outcome. Future trials should examine the effects of no interventions and different types of intravenous and oral fluids on these clinically important outcomes, and include women's perception and satisfaction with care during labour and birth.
Toohill
Jocelyn
J
Family, Women's and Children's, Gold Coast Hospital, 108 Nerang Street, Southport, Queensland, Australia, 4219. jocelyn_toohill@health.qld.gov.au
Soong
Barbara
B
Flenady
Vicki
V
D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D007662:Ketosis / Q000628:therapy*; D007743:Labor, Obstetric; D011247:Pregnancy