Peripartum hyponatraemia: an overview of physiology, prevention and management

Abstract

Key content Hyponatraemia in labour is a common but underreported condition. It can cause considerable complications, altering the management of labour, and fetal and maternal outcomes. Pregnant women are predisposed to hyponatraemia because of the physiological changes in water and sodium homeostasis occurring in pregnancy and the peripartum period. Prevention is key to improving women’s wellbeing in the peripartum period. Fluid balance charts, alongside the partogram, should be an integral part of any low and high‐risk labour management strategy. There is an urgent need for national guidance to enable clinicians to make appropriate decisions. Learning objectives To understand sodium homeostasis in pregnancy and be aware of the importance of fluid balance in labour. To know how to prevent hyponatraemia and to detect the condition in its early stages. To learn about the fetal impact of maternal hyponatraemia and the need for neonatal involvement in these cases.

Case Report of Hyponatremic Seizures in a Term Neonate Attributed to Excessive Maternal Coconut Water Ingestion During Labor

“…In addition, preeclampsia, adrenal insufficiency, hypothyroidism, and Sheehan's syndrome can induce severe electrolyte abnormalities and hyponatremia. 12,13 In this case, the neonate's hyponatremia was attributed to maternal hyponatremia from large-volume coconut water ingestion. Coconut water has gained popularity and is marketed as a natural fluid for rehydration.…”

“…In addition, preeclampsia, adrenal insufficiency, hypothyroidism, and Sheehan’s syndrome can induce severe electrolyte abnormalities and hyponatremia. 12,13…”

“…11 In labor, native and exogenous oxytocin can react with the vasopressin receptors and impart a mild antidiuretic effect, resulting in water retention. 12 Excess intravenous hypotonic fluid administration and consuming hypotonic beverages with reduced food intake can lead to reduced sodium levels. In addition, preeclampsia, adrenal insufficiency, hypothyroidism, and Sheehan's syndrome can induce severe electrolyte abnormalities and hyponatremia.…”