title: Association of epidural-related fever and noninfectious inflammation in term labor.
abstract: OBJECTIVE
  To investigate the role of infection and noninfectious inflammation in epidural analgesia-related fever.
  
  
  METHODS
  This was an observational analysis of placental cultures and serum admission and postpartum cytokine levels obtained from 200 women at low risk recruited during the prenatal period.
  
  
  RESULTS
  Women receiving labor epidural analgesia had fever develop more frequently (22.7% compared with 6% no epidural; P=.009) but were not more likely to have placental infection (4.7% epidural, 4.0% no epidural; P>.99). Infection was similar regardless of maternal fever (5.4% febrile, 4.3% afebrile; P=.7). Median admission interleukin (IL)-6 levels did not differ according to later epidural (3.2 pg/mL compared with 1.6 pg/mL no epidural; P=.2), but admission IL-6 levels greater than 11 pg/mL were associated with an increase in fever among epidural users (36.4% compared with 15.7% for 11 pg/mL or less; P=.008). At delivery, both febrile and afebrile women receiving epidural had higher IL-6 levels than women not receiving analgesia.
  
  
  CONCLUSIONS
  Epidural-related fever is rarely attributable to infection but is associated with an inflammatory state.
authors.affiliation: From the Departments of Obstetrics and Gynecology, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Clinical Microbiology Laboratory, and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Anesthesia, Critical Care and Pain Medicine, Division of Obstetric Anesthesia, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Riley
authors.forename: Ann C
authors.initials: AC
authors.lastname: Celi
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Onderdonk
authors.forename: Drucilla J
authors.initials: DJ
authors.lastname: Roberts
authors.forename: Lise C
authors.initials: LC
authors.lastname: Johnson
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Tsen
authors.forename: Lisa
authors.initials: L
authors.lastname: Leffert
authors.forename: May C M
authors.initials: MCM
authors.lastname: Pian-Smith
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Heffner
authors.forename: Susan T
authors.initials: ST
authors.lastname: Haas
authors.forename: Ellice S
authors.initials: ES
authors.lastname: Lieberman
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D016207:Cytokines / Q000097:blood; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011645:Puerperal Infection / Q000209:etiology*; D047929:Term Birth
chemical_list: D016207:Cytokines