Labor Epidural Analgesia and Intrapartum Maternal Hyperthermia

Abstract

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