Fluid balance monitoring
Fluid balance is described as the balance of the input and output of fluids in the body to allow metabolic processes to function correctly. The Mothers and Babies Reducing Risk through Audit and Confidential Enquiries in the United Kingdom report (MBRRACE 2014) recognises the significant impact that midwives have in the prevention of maternal and neonatal mortality and morbidity, especially where there are known pre-existing pathologies such as metabolic, cardiac or renal disease. Early clinical assessment and treatment can be crucial for women requiring fluid balance monitoring as part of diagnostic assessments or as part of higher dependency care interventions.
Assessments should include client reports and observations of signs and symptoms associated with abnormal fluid balance, which may relate to pre-existing or acute conditions. For example, late-stage dehydration may be suspected if a client reports feeling dry, thirsty, passing infrequent dark urine, constipation, headaches or dizziness. Similarly, late-stage dehydration in babies may be suspected through observations of increased pulse and respiration rate, drowsiness, infrequent urination and bowel movements and sunken fontanelles. Over hydration may be detected through systemic generalised puffiness, pulmonary changes such as rales or wheezing and excessive urinary excretion. Fluid balance monitoring awareness is a fundamental skill in effective maternity care and is relevant to all care settings whether it be a home or level 1–3 care environments.
Recommendations from triennial confidential enquires outline the clinical importance of accurate fluid balance in the management of pathological conditions of childbirth and the prevention of associated morbidities. In addition, basic clinical skills such as fluid balance monitoring underpin best management in Practical Obstetric Multi-Professional Training (PROMPT) and in situations such as basic life support, anaesthetic emergencies, pre-eclampsia/eclampsia, sepsis and major obstetric haemorrhage.