(950) Running Dry: Induction of Labor and Obstetric Outcomes during an Intravenous Fluid Shortage

In October 2024, catastrophic flooding caused by Hurricane Helene disrupted the global supply of intravenous fluids (IVF). Our hospital experienced a severe shortage of IVF. We investigated how practice changes in response to the shortage affected obstetric outcomes during induction of labor (IOL).

Study Design:

We conducted a retrospective cohort study of those with full term, viable pregnancies admitted for IOL between July 1 and December 31, 2024. We excluded those with comorbidities that would independently influence IVF prescribing (e.g. preeclampsia with severe features, pre-existing cardiac or renal disease). We compared outcomes before and after institutional changes in response to the IVF shortage. (Figure 1) Due to the immediate scarcity of IVF, no washout period was utilized. Statistical analysis was performed using chi square, fisher exact, and t-tests as appropriate.

Results:

We included 427 people pre-implementation and 320 people post-implementation. Post-implementation, there were higher rates of nulliparity (43% vs 51%, p=0.04), patients with preeclampsia without severe features (3% vs 8%, p=< 0.01), and medically indicated IOL (5% vs 13%,  p< 0.01). (Table 1) Intrapartum IVF administration was significantly reduced following implementation (2487mL vs 990mL, p< 0.01). (Figure 1) There were no differences in mode of delivery or length of labor, but there were more acute kidney injuries in the post-implementation group. Of the three renal injuries, two were attributed to hypovolemia after postpartum hemorrhage and one to nephrotoxic antibiotic administration. Neonates in the post-implementation group experienced a smaller reduction in birthweight at 24 hours (3.8% vs 3.0%, p< 0.001); there was no change in rate of exclusive breastfeeding.

Conclusion:

During the IVF shortage, intrapartum IVF use declined significantly. Despite this, we observed no differences in length of labor or mode of delivery. This study highlights opportunities to reevaluate routine intrapartum IVF management and underscores how climate change and natural disasters can affect obstetric practice and maternal health.