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Labor Epidural Analgesia and Intrapartum Maternal Hyperthermia

From the Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, Hawaii; and Division of Epidemiology, Statistics and Preventive Research, National Institute of Child Health and Human Development, Bethesda, Maryland.

Address reprint requests to: Michael K. Yancey, MD, Department of Obstetrics and Gynecology, MCHK-OB, 1 Jarrett White Road, TAMC, HI 96859-5000.

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.

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				S. Banerjee, P. Cashman, S. M. Yentis, and P. J. Steer Maternal Temperature Monitoring During Labor: Concordance and Variability Among Monitoring Sites Obstet. Gynecol., February 1, 2004; 103(2): 287 - 293. [Abstract] [Full Text] [PDF]