Effect of labor on maternal dehydration, starvation, coagulation, and fibrinolysis.
BACKGROUND
Dehydration, starvation, and enhanced blood coagulability may occur during labor.


METHODS
We studied 60 women who gave birth vaginally to a healthy singleton infant at term. Sampling of urine and blood specimens was performed on admission to the hospital with labor pains and just after birth. Paired samples were available from 50 women for urine analysis and 29 women for blood analysis. Total fluid intake (oral and intravenous) during labor was recorded. Changes in various parameters in the urine and blood in relation to the total fluid intake were analyzed.


RESULTS
Osmolality and creatinine concentration in the urine, red blood cell count, hemoglobin concentration, hematocrit value, thrombin-antithrombin III complex, plasmin-alpha 2-plasmin inhibitor complex and D dimer significantly increased during labor. Ketone bodies were absent in the urine in 84% (42/50) of women on admission to the hospital whereas these were present in 74% (37/50) of women just after delivery (p < 0.01). The degree of these changes appeared to be smaller with an increase in fluid intake.


CONCLUSIONS
Concentrated urine, hemoconcentration, starvation, and activation of the thrombogenic and fibrinolytic system occur in parturient women. Sufficient fluid intake during labor may ameliorate these unfavorable changes.
Watanabe
T
T
Department of Obstetrics and Gynecology, Institute of Hematology, Jichi Medical School, Tochigi, Japan. twatnabe@jicji.ac.jp
Minakami
H
H
Sakata
Y
Y
Matsubara
S
S
Tamura
N
N
Obara
H
H
Wada
T
T
Onagawa
T
T
Sato
I
I
D000293:Adolescent; D000328:Adult; D000933:Antifibrinolytic Agents / Q000097:blood; D000990:Antithrombin III; D001777:Blood Coagulation; D003404:Creatinine / Q000652:urine; D003681:Dehydration / Q000150:complications*; D004326:Drinking; D004435:Eating; D004906:Erythrocyte Count; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005341:Fibrinolysin; D005342:Fibrinolysis; D005440:Fluid Therapy; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007657:Ketone Bodies / Q000652:urine; D007744:Obstetric Labor Complications; D009994:Osmolar Concentration; D010447:Peptide Hydrolases / Q000097:blood; D011247:Pregnancy; D014556:Urine; D000979:alpha-2-Antiplasmin
D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; D006454:Hemoglobins; D007657:Ketone Bodies; D000979:alpha-2-Antiplasmin; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; C037742:plasmin-plasmin inhibitor complex; D000990:Antithrombin III; D003404:Creatinine; D010447:Peptide Hydrolases; D005341:Fibrinolysin