Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Sydney Institute for Women, Children and their Families, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Acta Obstet Gynecol Scand. 2024 Aug;103(8):1541-1549. doi: 10.1111/aogs.14896. Epub 2024 Jun 10.
There is a major research gap relating to the impact of intravenous (IV) fluids administration during labor on maternal and neonatal outcomes. It is biologically plausible that a relationship between volume of IV fluids and primary postpartum hemorrhage (PPH) exists. The primary objective of this study was to evaluate whether the administration of high-volume IV fluids during labor (≥ 2500 mL) increases the risk of primary PPH and other adverse outcomes for women with a term, singleton pregnancy, in comparison to low-volume IV fluids during labor (<2500 mL).
A retrospective cohort study was conducted at a tertiary referral hospital in Sydney, Australia between 1st September 2021 and 31st October 2022. Inclusion criteria were: women with a live singleton fetus in a cephalic presentation; planning a vaginal birth; and admitted for labor and birth care between 37 and 42 week gestation. The study factor was IV fluids during labor and the primary outcome was primary PPH ≥500 mL. Secondary outcomes included cesarean section and major perineal injury. Pregnancy, birth, and postnatal data were obtained from the hospital's electronic clinical database, 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 labor and PPH.
A total of 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]1.02 95% confidence interval [95%CI] 0.72, 1.44). However, there was a positive association between high-volume IV fluids and cesarean section (OR 1.99; 95%CI 1.4, 2.8).
The findings of this research are important to further knowledge relating to the administration of IV fluids during labor. The findings emphasize the importance of accurately documenting IV fluids administration and identifies research priorities to enable us to better understand the broader implications of IV fluids administration on pregnancy and perinatal outcomes.
在分娩期间静脉（IV）输液对母婴结局的影响方面存在重大研究空白。从生物学角度来看，IV 液体积与产后出血（PPH）之间存在关联是合理的。这项研究的主要目的是评估与分娩期间给予低容量 IV 液（<2500 毫升）相比，给予大容量 IV 液（≥2500 毫升）是否会增加足月、单胎妊娠妇女的原发性 PPH 及其他不良结局的风险。
这是一项在澳大利亚悉尼的三级转诊医院进行的回顾性队列研究，时间为 2021 年 9 月 1 日至 2022 年 10 月 31 日。纳入标准为：胎头位、单胎活产、计划阴道分娩、37-42 周妊娠、入院分娩。研究因素是分娩期间的 IV 液，主要结局是原发性 PPH≥500 毫升。次要结局包括剖宫产和主要会阴损伤。妊娠、分娩和产后数据来自医院的电子临床数据库、电子病历和纸质液体医嘱文档。多变量逻辑回归和多重插补用于探讨分娩期间 IV 液量与 PPH 之间的关系。
共纳入 1023 名参与者，其中 339 名发生原发性 PPH（33.1%）。在调整了人口统计学和临床因素后，大容量 IV 液与 PPH 之间无关联（调整后的优势比 [OR]1.02，95%置信区间 [95%CI]0.72，1.44）。然而，大容量 IV 液与剖宫产之间呈正相关（OR 1.99；95%CI 1.4，2.8）。
本研究的结果对进一步了解分娩期间 IV 液的应用具有重要意义。研究结果强调了准确记录 IV 液输注的重要性，并确定了研究重点，以使我们能够更好地理解 IV 液输注对妊娠和围产期结局的更广泛影响。
