From the Guidelines
Normal saline (NS) intravenous fluid is generally safe for pregnant women at 34 weeks gestation when medically indicated, but it's crucial to use balanced crystalloids, such as Ringer’s lactate, instead of 0.9% saline to avoid salt and fluid overload 1. The use of NS should be carefully considered, as the goal is to maintain intravascular volume and ensure adequate tissue and organ perfusion while avoiding electrolyte imbalances. Some key points to consider:
- Optimal preoperative fluid intake and avoiding bowel preparation can help ensure the patient arrives in hospital well hydrated.
- Intraoperatively, most patients will require balanced crystalloids, and the use of 0.9% saline should be avoided due to the risk of salt and fluid overload 1.
- Postoperatively, IVF should be discontinued at the latest during day 1, and patients should be encouraged to drink when fully recovered and offered an oral diet within 4 hours after abdominal/pelvic surgery 1. It's essential to consult with an obstetrician before receiving any IV fluids during pregnancy, as individual health conditions may require different fluid types or concentrations. Additionally, other studies suggest that pregnant women at high or moderate risk of pre-eclampsia should take low-dose acetylsalicylic acid (aspirin) daily from week 12 to weeks 36–37, and high-dose calcium supplementation may reduce the risk of pre-eclampsia and pre-term birth 2. However, the primary concern is to prioritize the use of balanced crystalloids over NS to minimize the risk of complications, as recommended by the most recent and highest-quality study 1.
From the Research
NS IV Fluid for 34 Weeks Pregnant
- The provided studies do not directly address the use of NS IV fluid in 34-week pregnant women.
- However, a study on normal saline i.v. fluid load during active labor found that it decreases uterine activity 3.
- Another study compared the use of normal saline with other solutions in critically ill patients and found that NS may reduce the onset of acute kidney injury (AKI) when compared with 6% hydroxyethyl starch (HES) 4.
- A comparison of 5% dextrose in 0.9% normal saline versus non-dextrose-containing crystalloids as the initial intravenous replacement fluid in elective surgery found that patients receiving normal saline remained normoglycaemic throughout the study period 5.
- A study on the management of severely dehydrated patients with choleriform diarrhoea found that Lactated Ringer's solution corrected acidosis more quickly than sodium chloride 0.9% 6.
- There is no direct evidence to suggest that NS IV fluid is not okay for 34 weeks pregnant women, but it is essential to consider individual patient conditions when prescribing intravenous fluids 4.