Evidence-based obstetric guidance in the setting of a global intravenous fluid shortage

Sarah Heerboth, Paulina M. Devlin, Savvy Benipal, Emma Trawick, Nandini Raghuraman, Elizabeth Coviello, Erin E. Brown, Johanna Quist-Nelson

Research output: Contribution to journalReview articlepeer-review

Abstract

Intravenous fluid (IVF) administration is a ubiquitous medical intervention. Although there are clear benefits to IVF in certain obstetric scenarios, IVF is often given in unindicated circumstances; the ongoing IVF shortage highlights an opportunity to reduce unindicated IVF in obstetrics. This document provides evidence-based recommendations to reduce IVF use within general obstetric practice. The three sections address IVF use within (1) antepartum care, (2) intrapartum care, and (3) postpartum care, including postpartum hemorrhage (PPH) risk reduction. Using the GRADE framework, we provide a summary of the available evidence surrounding use of IVF in obstetrics and recommend strategies to reduce IVF. We recommend transitioning intravenous (IV) antibiotics to IV push or oral when possible, discontinuing IVF bolus prior to neuraxial anesthesia or for the treatment of preterm labor, and avoiding unnecessary continuous IVF infusions. There may be further opportunities for fluid conservation with IV medications that could be given intramuscularly. These suggestions for IVF use reduction should be evaluated based on local need and capabilities as well as the characteristics and risk factors of the population. Patients with sepsis, PPH, burns, diabetic ketoacidosis, and hemodynamic instability should not have a reduction in IVF administration as these diagnoses have evidence-based resuscitation guidelines that include IVF. The recommendations presented may be applicable beyond the immediate IVF shortage and should be considered as an area for future research.

Original languageEnglish
Article number101556
JournalAmerican Journal of Obstetrics and Gynecology MFM
Volume6
Issue number12
DOIs
StatePublished - Dec 2024

Keywords

  • intravenous fluid
  • labor
  • obstetric complications
  • obstetrics

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