Intravenous therapy during labour is a widespread practice.   Fluid administration is used as a preload for epidural analgesia, given as a bolus for abnormal fetal heart rate tracings, for elevated maternal temperatures, as a vehicle for medication administration,  a background infusion while epidural analgesia is in situ, and in the event of a caesarean section or intrapartum complications.

Fluid overload is one of the risks related to IV fluid therapy in labour.  The exact prevalence of intrapartum fluid overload is not known but the risks associated with this outcome have been described in the literature.  Physiologic changes accompany fluid overload and these include increased cardiovascular work, myocardial ischemia and pulmonary edema.

The effects of intrapartum fluid overload are not limited to the mother.  It has been suggested that intrapartum fluid overload affects the newborn as well and this is evidenced by respiratory distress, acidosis and exaggerated weight loss in the fluid overloaded newborn.   Managing fluid balance for labouring women is part of good intrapartum, interdisciplinary care and deserves more attention.

This case study presentation will focus on approaches to intrapartum fluid management.  Cases of fluid overload will be reviewed highlighting risks for mothers and infants.  A review of the literature on fluid management in labour will guide understanding of what is known and what is believed about fluid management.  Recommendations will be made regarding conservative approaches to fluid administration that aim to replace losses, maintain fluid balance and maternal and fetal safety.