(415) Effect of Intravenous Fluid Restriction on Nulliparous, Term, Singleton, Vertex Cesarean Delivery Rates

During the 2024 nationwide intravenous (IV) fluid shortage, our hospital implemented a restricted protocol for laboring patients. Previously, patients received 125 mL/hr of maintenance IV fluids; during the shortage, this was reduced to 10 mL/hr to keep the line open while encouraging oral hydration. Given limited data on optimal IV fluid rate in labor, we evaluated whether IV fluid restriction in labor affected cesarean delivery (CD) rates among nulliparous, term, singleton, vertex (NTSV) pregnancies.


Study Design:

This was a retrospective cohort study of all NTSV patients at a quaternary care hospital. Patients laboring during the IV fluid shortage (minimal fluid group; 10/2024-2/2025) were compared to those laboring during the same months in the two preceding years (standard fluid group; 10/2022-2/2023 and 10/2023-2/2024). Data on demographics, labor characteristics, and delivery outcomes were abstracted from medical records. Our primary outcome was NTSV CD rate and our secondary outcomes included total IV fluid intake in labor and total labor time. T-test, chi-square, and Wilcoxon rank-sum were used as appropriate.


Results:

Of 2,506 NTSV patients, 832 were in the minimal IV fluid group and 1,674 were in the standard IV fluid group. The minimal IV fluid group had higher birth weights and was more likely to have public insurance. The minimal IV fluid group received less total IV fluids during labor (median [IQR] 873 mL [1124] vs. 2365 mL [1997], P< 0.01). There was no difference in NTSV CD rates (28.4% vs 30.7%, P=0.23), indication for cesarean delivery, or in total labor time (median [IQR] 16.7 hours [13.7] vs. 16.4 hours [14.0], P=0.23) between the groups. However, Terbutaline was administered more in the minimal fluid group (12.9% vs. 8.8%, P< 0.01).


Conclusion:

Cesarean delivery rates in NTSV patients were not negatively impacted by a minimal IV fluid protocol, suggesting that oral hydration may be sufficient in resource-limited settings. However, increased need for terbutaline in this group does suggest higher rates of tachysystole, so attention to fetal monitoring should be emphasized.