Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Use of intravenous fluids in labour – a single centre online survey of obstetricians’ and anaesthetists’ perspectives (#91)

Siaw Hui Wong 1 2 , Meredith Tassone 1 , Suet-Wan Choy 1 2 3
  1. Department of Obstetrics and Gynaecology, Mercy Health, Heidelberg, Victoria, Australia
  2. Department of General Medicine, Austin Health, Heidelberg, Victoria, Australia
  3. Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia

Background:

There is conflicting evidence regarding the benefits or harms with intrapartum intravenous fluid therapy (IVT). Our previous retrospective study investigating local IVT prescription practices in labour found 63% (136/217) of women with low risk pregnancies received a median of 2L of compound sodium lactate (CSL) solution and women who received IVT had longer and complex labours compared to those who did nota. A survey was conducted to explore factors influencing intrapartum IVT prescription practices.

 

Methods:

Obstetricians and anaesthetists at a single tertiary centre were identified via employment records. Participants were invited to complete an online survey that ran for 6 weeks. Participants’ demographics, intrapartum IVT choice, and IVT prescription patterns were assessed.

 

Results:

177 potential participants were identified and 45 responded to the survey. 69% (n=31) were obstetricians and 93% chose CSL as their preferred IVT. 61% identified IVT as appropriate pre-emergency caesarean with the most common IVT indications cited as hypotension (40%), haemorrhage (30%) and anaesthesia (21%). Most would administer IVT boluses for hypotension (100%), non-reassuring cardiotocographs (CTG) (74%), spinal anaesthesia (66%) and tachycardia (56%). The top 3 reasons for IVT infusions were oxytocin use (96%), prolonged second stage of labour (45%) and postpartum haemorrhage (34%). All would not prescribe IVT for intravenous antibiotics.

                             

Conclusion:

This is the first survey to investigate intrapartum IVT prescription practices of obstetricians and anaesthetists. Haemodynamic instability, haemorrhage, prolonged labour, oxytocin and anaesthesia use were identified as common IVT indications.  This could explain the association in our previous study between IVT use in labour and higher rates of labour induction, augmentation, instrumental deliveries and emergency caesareansa. Interestingly, most would administer IVT for non-reassuring CTGs, which contradicts best practice guidelinesb. Furthermore, none would prescribe IVT for intravenous antibiotics, which contrasts our previous finding of a positive association between intrapartum IVT and intravenous antibioticsa. Further studies are required to evaluate optimal IVT prescription practices in labour.

 

References:

aSociety of Obstetric Medicine of Australia and New Zealand (SOMANZ) Annual Scientific Meeting Abstracts, 11–13 October 2019, Melbourne, Australia. Obstetric Medicine. 2019; 12(2_suppl):3-57.

bChandraharan E. Maternal “Oxygen and Fluids Therapy” to correct abnormalities in the cardiotocograph (CTG): scientific principles versus historical (mal)practices. Journal of Advances in Medicine and Medical Research 2020; 32(8): 10-16.