Labor epidural analgesia and intrapartum maternal hyperthermia1 ,

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Abstract

OBJECTIVE:

To determine if women receiving continuous epidural analgesia are more likely to develop intrapartum fever and related neonatal effects.

METHODS:

We conducted a retrospective cohort analysis of nulliparous women with term gestations in spontaneous labor delivered during a 12-month period immediately before the availability of on-demand labor epidural analgesia (Before group) and a similar group of nulliparas delivered after labor epidural analgesia was available on request (After group).

RESULTS:

The frequency of epidural increased from 1% before the availability of on-request epidural analgesia to 83% after epidural analgesia was available on request. A maximal temperature of at least 100.4F was detected in three of 498 (0.6%) women in the Before group, and in 63 of 572 women (11.0%) in the After group (relative risk [RR] = 18.3, 95% confidence interval [CI] 5.8, 57.8, P < .01). Logistic regression analysis demonstrated that on-request labor epidural analgesia was associated with an intrapartum temperature of at least 99.5F (RR = 3.0, 95% CI 2.3, 3.6, P < .001) and intrapartum temperature of at least 100.4F (RR = 20.2, 95% CI 7.0, 86.0, P < .001). There were statistically significant increases in the proportion of newborns who had complete blood counts (24% versus 13.5%, RR = 1.5, 95% CI 1.3, 1.8, P < .01) and blood cultures (30.7% versus 8.6%, RR = 1.7, 95% CI 1.2, 2.4, P < .05) in the After period compared with the Before group; however, there was no statistically significant difference in the proportion of infants who received antibiotic therapy for presumed sepsis between the After and Before periods (5.8% versus 4.6%, RR = 1.15, 95% CI 0.8, 1.6, P = .38). No infants in either group had culture-proven sepsis.

CONCLUSION:

The use of labor epidural analgesia is associated with a clinically significant increase in the incidence of intrapartum fever.

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

References (17)

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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.

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