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.

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