From the Guidelines
Fluid overload during labor can lead to severe complications, including maternal pulmonary edema, cardiovascular work increase, and newborn infant weight loss, emphasizing the need for careful fluid management. The consequences of fluid overload during labor are multifaceted, affecting both the mother and the baby. For the mother, excessive intravenous fluid administration can cause pulmonary edema, presenting as difficulty breathing, decreased oxygen saturation, and crackles on lung examination, as well as increased cardiovascular work and potential for electrolyte imbalances, such as hyponatremia, which may lead to headaches, confusion, seizures, or even coma in severe cases 1.
Maternal Complications
- Pulmonary edema
- Increased cardiovascular work
- Electrolyte imbalances, particularly hyponatremia
- Potential for masking blood loss during delivery and complicating the assessment of postpartum hemorrhage
Fetal and Newborn Complications
- Neonatal hyponatremia
- Excessive weight loss after birth
- Potential for edema in the birth canal tissues to impede the progress of labor
To prevent these complications, careful fluid management is essential during labor, with a focus on maintaining perioperative euvolemia, which is crucial for optimal outcomes after cesarean delivery, as it determines not only blood pressure but also cardiac output and oxygen delivery 1. The physiological basis for these complications stems from the already increased blood volume and cardiac output during pregnancy, making pregnant women more susceptible to the adverse effects of excessive fluid administration. Therefore, fluid status should be regularly assessed through vital signs, urine output, and physical examination, and crystalloid infusion should be limited to 125-150 mL/hour unless there are specific indications for additional volume.
From the Research
Consequences of Fluid Overload During Labor
- Fluid overload can trigger maternal pulmonary edema in patients with no primary cardiac disease, especially when receiving terbutaline and glucocorticoids for treatment of premature labor 2.
- Acute pulmonary edema (PE) affects 0.08% to 1.5% of women during pregnancy and in the postpartum, with fluid overload being an important trigger in some cases 3.
- The most common attributable causes of pulmonary edema in pregnancy include tocolytic use, cardiac disease, fluid overload, and preeclampsia, with fluid overload being identified as the likely etiology in 21.5% of cases 4.
- Fluid overload can lead to increased mortality and several complications, including pulmonary edema, cardiac failure, delayed wound healing, tissue breakdown, and impaired bowel function 5.
- In critically ill patients, fluid overload recognition and assessment requires an accurate documentation of intakes and outputs, and treatment may involve diuretics, especially loop diuretics, or extracorporeal therapies 5.
Clinical Presentation and Management
- Acute pulmonary edema can occur antepartum, postpartum, or intrapartum, with most cases occurring antepartum and associated with hypertension 3.
- The diagnosis of pulmonary edema is often made based on clinical presentation, fluid balance, and coexisting maternal illness, with treatment aiming to restore cardiac output, systemic blood pressure, and renal perfusion 4, 5.
- Close liaison between obstetricians and other specialties is essential in the management of pregnant women with acute pulmonary edema, especially in cases where fluid overload is suspected to be a contributing factor 6.