Labor epidural analgesia and intrapartum maternal hyperthermia.
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.


CONCLUSIONS
The use of labor epidural analgesia is associated with a clinically significant increase in the incidence of intrapartum fever.
Yancey
M K
MK
Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, Hawaii 96859-5000, USA.
Zhang
J
J
Schwarz
J
J
Dietrich
C S
CS
Klebanoff
M
M
D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D016015:Logistic Models; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology*; D010298:Parity; D011247:Pregnancy; D012189:Retrospective Studies