ABSTRACT
Objective: To evaluate whether the administration of
high-volume intravenous (IV) fluids during labour (≥ 2500 mL) increases
the risk of primary postpartum haemorrhage (PPH) and other adverse
outcomes for women with a term, singleton pregnancy, in comparison to
low-volume IV fluids during labour (<2500 mL).
Design: Retrospective cohort study
Setting: Tertiary referral hospital in Sydney, Australia
Sample: 1023 women with a live singleton fetus in a cephalic
presentation; planning a vaginal birth; and admitted for labour and
birth care between 37 - 42 weeks gestation.
Methods: The study factor was IV fluids during labour. Birth
and postnatal data were obtained from electronic medical records and
paper fluid order documentation. Multivariable logistic regression and
multiple imputation were used to explore the relationship between volume
of IV fluids in labour and PPH.
Main outcome measures: The primary outcome was primary PPH ≥
500mL. Secondary outcomes included caesarean section and major perineal
injury.
Results: 1023 participants were included of which 339 had a
primary PPH (33.1%). There was no association between high-volume IV
fluids and PPH after adjusting for demographic and clinical factors
(Adjusted odds ratio [ORadj]1.02 95% confidence
interval [95%CI] 0.72, 1.44). However, there was a positive
association between high-volume IV fluids and caesarean section
(ORadj 1.99; 95%CI 1.4, 2.8).
Conclusion: These findings are important to further knowledge
relating to administration of IV fluids in labour and the potential
impact of this common practice. It identifies future research priorities
around documentation of IV fluids and their relationship with pregnancy
and perinatal outcomes.