Balance scale showing the balance between intravenous fluids and blood clotting factors in postpartum hemorrhage management.

Clear Fluids After Childbirth: How Much Is Too Much?

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Lena Kashyap in Health & Wellness November 2025 • 5 min read.

"New research sheds light on the delicate balance of fluid management during postpartum hemorrhage, offering vital insights for safer childbirth practices."


Postpartum hemorrhage, or excessive bleeding after childbirth, remains a leading cause of maternal health issues globally. When this occurs, rapid administration of intravenous fluids is a common practice to stabilize the mother, but new research suggests that the type and amount of fluid given can significantly impact outcomes.

Traditionally, medical guidelines have suggested infusing specific amounts of crystalloid and colloid solutions while awaiting blood transfusions. However, these recommendations were largely based on expert opinions rather than concrete data. A recent nationwide study has investigated how different volumes of clear fluids affect coagulation parameters—essential components in blood clotting—in women experiencing severe postpartum hemorrhage.

This article breaks down the study's findings, explaining how excessive clear fluids can lead to dilutional coagulopathy, a condition where the blood's ability to clot is impaired. Understanding this balance is crucial for healthcare providers aiming to optimize fluid management and improve maternal safety during and after childbirth.

The Fluid Balance Act: How Clear Fluids Affect Blood Clotting

Balance scale showing the balance between intravenous fluids and blood clotting factors in postpartum hemorrhage management.

The Dutch study, which retrospectively analyzed data from over a thousand women, categorized fluid administration into three strategies based on the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines: less than 2 liters, 2 to 3.5 liters, and more than 3.5 liters of clear fluids. Researchers then assessed how these different volumes correlated with key coagulation parameters, including hemoglobin, hematocrit, platelet count, fibrinogen, aPTT, and PT levels.

The results indicated a clear association between the volume of clear fluids administered and the levels of these coagulation parameters. Specifically, higher volumes of clear fluids were linked to lower levels of hemoglobin, hematocrit, platelet count, and fibrinogen, along with prolonged aPTT. This suggests that excessive clear fluids can dilute the blood, impairing its ability to clot effectively.

  • Hemoglobin and Hematocrit: Higher fluid volumes correlated with reduced levels of hemoglobin (the oxygen-carrying protein in red blood cells) and hematocrit (the proportion of red blood cells in the blood).
  • Platelet Count: The number of platelets, which are crucial for forming blood clots, decreased with increasing fluid administration.
  • Fibrinogen: This essential protein, which helps form blood clots, also showed lower levels with higher fluid volumes.
  • aPTT and PT Levels: These measures of blood clotting time were prolonged, indicating that the blood took longer to clot as fluid volumes increased.
These findings highlight the risk of dilutional coagulopathy, where excessive clear fluids compromise the concentration of vital clotting factors, potentially exacerbating bleeding during postpartum hemorrhage. It is important to note that signs of shock was also compared in all fluid categories, women were administered fewer blood products when compared to women in the other fluid categories for all coagulation parameters.

Rethinking Fluid Resuscitation: Towards Safer Guidelines

This study provides compelling evidence supporting a more restrictive approach to fluid resuscitation in women experiencing postpartum hemorrhage. While intravenous fluids are essential for maintaining hemodynamic stability, the findings suggest that excessive administration of clear fluids can do more harm than good by diluting critical clotting factors.

The study's conclusions reinforce the importance of individualized care and careful monitoring of coagulation parameters during postpartum hemorrhage. Healthcare providers should consider limiting clear fluid administration to the minimum necessary to maintain blood pressure and oxygen delivery, while prioritizing blood product transfusions to replace lost clotting factors.

Ultimately, this research contributes valuable data to refine existing guidelines and promote safer, more effective management of postpartum hemorrhage, ensuring better outcomes for mothers worldwide. By understanding the delicate balance of fluid management, medical professionals can optimize their approach to this common and potentially life-threatening complication of childbirth.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1186/s12884-018-2021-9, Alternate LINK

Title: Association Between Fluid Management And Dilutional Coagulopathy In Severe Postpartum Haemorrhage: A Nationwide Retrospective Cohort Study

Subject: Obstetrics and Gynecology

Journal: BMC Pregnancy and Childbirth

Publisher: Springer Science and Business Media LLC

Authors: Ada Gillissen, Thomas Van Den Akker, Camila Caram-Deelder, Dacia D C A Henriquez, Kitty W M Bloemenkamp, Jos J M Van Roosmalen, Jeroen Eikenboom, Johanna G Van Der Bom

Published: 2018-10-11

Everything You Need To Know

1

What is postpartum hemorrhage, and why is fluid management important in this context?

Postpartum hemorrhage is excessive bleeding after childbirth, a leading global cause of maternal health issues. Rapid administration of intravenous fluids is often used to stabilize the mother. The study highlights the critical link between fluid management and coagulation, showing that the type and amount of clear fluids significantly impact outcomes.

2

What is dilutional coagulopathy, and why is it a concern after childbirth?

Dilutional coagulopathy occurs when excessive clear fluids compromise the concentration of vital clotting factors in the blood. This impairment can exacerbate bleeding during postpartum hemorrhage because it reduces the blood's ability to clot effectively. The study showed a clear association between the volume of clear fluids and the levels of coagulation parameters like hemoglobin, hematocrit, platelet count, and fibrinogen.

3

Which specific blood parameters are affected by fluid administration, and how are they impacted?

Key coagulation parameters include hemoglobin, hematocrit, platelet count, fibrinogen, aPTT, and PT levels. Higher volumes of clear fluids correlate with lower levels of hemoglobin and hematocrit, indicating reduced oxygen-carrying capacity. Decreased platelet count impacts clot formation. Lower fibrinogen levels also impair clotting. Prolonged aPTT and PT levels show the blood takes longer to clot.

4

How did the study categorize fluid administration volumes, and what was the methodology?

The study categorized fluid administration into three groups: less than 2 liters, 2 to 3.5 liters, and more than 3.5 liters of clear fluids. Researchers assessed the correlation between these volumes and coagulation parameters. This retrospective analysis used data from over a thousand women, providing valuable insights into the impact of fluid volumes during postpartum hemorrhage.

5

What is the main conclusion regarding fluid resuscitation, and what are the implications for clinical practice?

The study's findings support a more restrictive approach to fluid resuscitation. While intravenous fluids are crucial for maintaining hemodynamic stability, excessive administration of clear fluids can dilute critical clotting factors, potentially worsening outcomes. The findings advocate for optimizing fluid management during postpartum hemorrhage to improve maternal safety. This involves a balance between providing enough fluid to stabilize the mother and avoiding excessive volumes that could lead to complications.

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