Association between intravenous fluids during labour and primary
postpartum haemorrhage: A retrospective cohort study
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 [OR adj]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 (OR
adj 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.