Labor epidural analgesia and intrapartum maternal hyperthermia1 ☆,
Section snippets
Materials and methods
Tripler Army Medical Center is a large tertiary care facility located on the island of Oahu and is the sole military facility providing in-patient obstetric care to military personnel and their family members located in the Hawaiian Islands. There is a resident training program in obstetrics and gynecology, and approximately 3000 deliveries per year are performed at this institution. The patient population is relatively homogenous in socioeconomic status, with housing provided for all families,
Results
The methods for study population selection are described in Table 1. Data were initially analyzed for 507 women who fulfilled eligibility criteria in the study period before the availability of on-request labor epidural analgesia and 581 women delivered during the period of on-request labor epidural analgesia. Maternal temperature of at least 99.5F was detected upon admission in nine women in the Before group and nine women in the After group. These women were excluded from further analysis
Discussion
Larue et al initially proposed a link between labor epidural analgesia and maternal hyperthermia in 1987.9 This association was strengthened by Fusi et al in 1989 who found women receiving labor epidural analgesia to have an increased mean intrapartum temperature when compared to a control group of women receiving intravenous narcotic analgesia.10 Subsequently, numerous randomized, controlled trials and retrospective cohort studies have demonstrated an increase in intrapartum fevers in women
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Cited by (82)
Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment
2024, American Journal of Obstetrics and GynecologyMaternal fever in labor: etiologies, consequences, and clinical management
2023, American Journal of Obstetrics and GynecologyEpidural-related maternal fever: incidence, pathophysiology, outcomes, and management
2023, American Journal of Obstetrics and GynecologySeverity of intrapartum fever and neonatal outcomes
2022, American Journal of Obstetrics and GynecologyCitation Excerpt :Intrapartum fever can be caused by noninfectious events, such as epidural analgesia, prostaglandin E2 use, dehydration, hyperthyroidism, and excess ambient heat, or it can be caused by infections such as clinical chorioamnionitis or intraamniotic infection.4 Previous studies have demonstrated that epidural placement can increase the risk of developing an intrapartum fever, but data are mixed on whether epidural placement increases the risk of chorioamnionitis or other infection-mediated fevers.5–7 Regardless of etiology, intrapartum maternal fever has been linked to increased rates of neonatal morbidity, including low Apgar scores, respiratory distress, neonatal sepsis, meconium aspiration, neonatal encephalopathy, neonatal seizures, and neonatal intensive care unit (NICU) admission.8–13
Chorioamnionitis and its association with neonatal and maternal adverse outcomes in women with and without epidural analgesia administration
2022, European Journal of Obstetrics and Gynecology and Reproductive BiologyFever during labour epidural analgesia
2018, Trends in Anaesthesia and Critical CareCitation Excerpt :The knowledge of the association between labour epidural analgesia and maternal fever has been based on studies looking at possible pathophysiological mechanisms, risk stratification and potential treatment options. Multiple observational studies (both prospective [8,18–21] and retrospective [10,22–25]), randomized controlled trials [3–5,26–32] and one before and after study [6] have suggested that the phenomenon of maternal fever is indeed associated with labour epidural analgesia. However, this topic is still controversial as one observational study [33,34] and a few randomized controlled trials [35,36] have found no difference in maternal temperature with labour epidural analgesia.
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This work was supported by Interagency Agreement between the National Institute of Child Health and Human Development and Tripler Army Medical Center No. YI-HD-8290.
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The opinions and assertions contained herein are the expressed views of the authors and are not to be construed as official or reflecting the opinions of the Department of Defense or the Department of the Army.