Effect of preoperative 5% dextrose versus 0.9% normal saline on perioperative blood loss during elective cesarean delivery under spinal anesthesia: a double-blind randomized controlled trial

Abstract Background Obstetric hemorrhage remains a leading cause of maternal morbidity and mortality worldwide. Evidence regarding the effect of preoperative intravenous glucose administration on perioperative blood loss during cesarean delivery is limited. This study evaluated whether preoperative intravenous dextrose reduces perioperative blood loss. Methods In this prospective, double-blind randomized controlled trial, 60 term women undergoing elective cesarean delivery under spinal anesthesia were randomly assigned (1:1) to receive either 500 mL of 5% dextrose (25 g glucose; n = 30) or 500 mL of 0.9% normal saline ( n = 30) before anesthesia. All randomized participants completed follow-up and were included in the intention-to-treat analysis. The primary outcome was intraoperative blood loss. Secondary outcomes were exploratory. Results Compared with the control group, participants receiving dextrose had lower intraoperative blood loss, the prespecified primary outcome (mean difference − 148.33 mL; 95% CI, − 184.78 to − 111.88; p < 0.001). Exploratory secondary analyses also showed lower recovery-room blood loss (mean difference − 167.00 mL; 95% CI, − 201.67 to − 132.33; p < 0.001) and a smaller perioperative hemoglobin decline (mean difference − 0.82 g/dL; 95% CI, − 0.96 to − 0.68; p < 0.001). Maternal blood glucose was higher in the dextrose group ( p < 0.001). Neonatal glucose concentrations did not differ significantly between groups. Conclusions In this single-center randomized trial, preoperative 5% dextrose administration was associated with lower perioperative blood loss during elective cesarean delivery. Given the modest sample size, exploratory secondary outcomes, and limited neonatal safety assessment, these findings should be confirmed in larger multicenter trials before routine clinical implementation. Trial Registration Iranian Registry of Clinical Trials (IRCT): IRCT20100102002963N39. Registered on 21 September 2025. Prospectively registered before participant enrollment.