There is uncertainty regarding how much intravenous fluid should be given to women in the intrapartum period. There are no published protocols or guidelines available to address fluid management in labour to optimize care for women and their infants. The absence of an evidence-based approach to intrapartum fluid management may result in fluid overload, with consequent maternal and newborn morbidity. The FILL Trial sought to answer the question, for low risk women receiving epidural analgesia in labour, ‘what is the effect of a conservative protocol for fluid management versus usual care on breastfed newborns’ weight loss prior to hospital discharge? The FILL Trial was a single site randomized controlled trial comparing a conservative protocol of fluid management with usual care for low risk women receiving epidural analgesia in labour. Women in the conservative care group received an IV volume prior to epidural analgesia initiation of < 500 ml and an IV infusion rate of 110 ml per hour. Women in the usual care group received an IV volume prior to epidural analgesia initiation of >500 ml and an IV infusion rate of 200 ml per hour. The primary outcome of interest was the proportion of breastfed infants who lost > 7% of their birth weight prior to discharge. Two hundred women participated, 100 in the conservative care group and 100 in the usual care group. Forty-four infants in the conservative care group and 48 infants in the usual care group lost > 7% of their birth weight, p=0.57. There were no statistically significant differences between groups for breastfeeding outcomes or measures of newborn well being. More babies in the conservative care group required initial admission to the neonatal intensive care unit for septic work up for maternal fever. No septic work ups of the babies yielded positive results. More instrumental vaginal deliveries occurred in the conservative care group. No change in current practice is warranted for intrapartum intravenous fluid volumes < 2500 ml. Future research should focus on the creation of more evidence regarding safe volumes of intravenous fluid during labour.

There is uncertainty regarding how much intravenous fluid should be given to women in the intrapartum period. There are no published protocols or guidelines available to address fluid management in labour to optimize care for women and their infants. The absence of an evidence-based approach to intrapartum fluid management may result in fluid overload, with consequent maternal and newborn morbidity. The FILL Trial sought to answer the question, for low risk women receiving epidural analgesia in labour, ‘what is the effect of a conservative protocol for fluid management versus usual care on breastfed newborns’ weight loss prior to hospital discharge? The FILL Trial was a single site randomized controlled trial comparing a conservative protocol of fluid management with usual care for low risk women receiving epidural analgesia in labour. Women in the conservative care group received an IV volume prior to epidural analgesia initiation of < 500 ml and an IV infusion rate of 110 ml per hour. Women in the usual care group received an IV volume prior to epidural analgesia initiation of >500 ml and an IV infusion rate of 200 ml per hour. The primary outcome of interest was the proportion of breastfed infants who lost > 7% of their birth weight prior to discharge. Two hundred women participated, 100 in the conservative care group and 100 in the usual care group. Forty-four infants in the conservative care group and 48 infants in the usual care group lost > 7% of their birth weight, p=0.57. There were no statistically significant differences between groups for breastfeeding outcomes or measures of newborn well being. More babies in the conservative care group required initial admission to the neonatal intensive care unit for septic work up for maternal fever. No septic work ups of the babies yielded positive results. More instrumental vaginal deliveries occurred in the conservative care group. No change in current practice is warranted for intrapartum intravenous fluid volumes < 2500 ml. Future research should focus on the creation of more evidence regarding safe volumes of intravenous fluid during labour.

Introducción: La valoración del estado nutricional de las gestantes es fundamental para lograr un estado óptimo de ellas y de sus hijos. Objetivo: Determinar la relación entre la ganancia de peso gestacional y el peso del recién nacido en puérperas atendidas en el Servicio de Ginecología del Centro Médico Naval. Materiales y métodos: Estudio cuantitativo, descriptivo de tipo correlacional y transversal. La población estuvo conformada por 61 puérperas y sus recién nacidos en el Centro Médico Naval. Se trabajó con la población encontrada durante el periodo de agosto a setiembre donde se diseñó una ficha para la recolección de datos. Para el análisis estadístico se utilizaron las pruebas de Rho de Spearman y coeficiente de contingencia de Pearson. Resultados: La edad materna promedio fue de 29± 4.27 años, la mitad estaba casada con grado de instrucción superior. En índice de masa corporal pre gestacional de las puérperas fue para normal de 52.5%; sobrepeso, 41% y; obesas ,6.6%. Correspondiendo al 49% de gestantes con ganancia adecuada; mientras que la ganancia inadecuada por exceso fue del 31.1% y 19.6% a ganancia insuficiente de peso. Los recién nacidos con macrosomía representó el 4.9%. Se obtuvo correlación no significativa entre la ganancia de peso gestacional y el peso del recién nacido, según pruebas estadísticas por Spearman ρ (rho)=0.083 y por coeficiente de contingencia de Pearson (CC= 0.35). Conclusiones: No se evidenció una relación significativa entre la ganancia de peso gestacional y el peso del recién nacido. El promedio de edad fue 29.72 años, la mayoría de procedencia costeña, casadas y con grado de instrucción superior. Asimismo, se evidencio que un 49% alcanzo un peso adecuado, 20% bajo peso y 31% peso excesivo. En cuanto al recién nacido un 95.1% fueron normosómicos y un 4.9% macrosómico. / Introduction: The assessment of the nutritional status of pregnant women is essential to achieve an optimal state of them and their children. Objective: To determine the relationship between gestational weight gain and the weight of the newborn in postpartum nurses treated in the Gynecology Service of the Naval Medical Center. Materials and methods: Quantitative, descriptive, correlational and cross-sectional study. The population consisted of 61 puerperal women and their newborns at the Naval Medical Center. We worked with the population found during the period from August to September where a file for data collection was designed. For the statistical analysis, Spearman's Rho tests and Pearson's contingency coefficient were used. Results: The average maternal age was 29 ± 4.27 years, half were married with higher education. In the pre-gestational body mass index of the puerperal women, it was normal for 52.5%; overweight, 41% and; obese, 6.6%. Corresponding to 49% of pregnant women with adequate earnings; while the inadequate excess gain was 31.1% and 19.6% to insufficient weight gain. Newborns with macrosomia accounted for 4.9%. No significant correlation was obtained between gestational weight gain and newborn weight, according to statistical tests by Spearman ρ (rho) = 0.083 and by Pearson's contingency coefficient (CC = 0.35). Conclusions: There was no significant relationship between gestational weight gain and newborn weight. The average age was 29.72 years, most of them from the coast, married and with a higher education level. Likewise, it was evidenced that 49% reached an adequate weight, 20% underweight and 31% overweight. As for the newborn, 95.1% were normosomal and 4.9% macrosomic. / Trabajo de investigación