Epidural-related maternal fever: incidence, pathophysiology, outcomes, and management

Patel, Sneh; Ciechanowicz, S.; Blumenfeld, Yair J.; Sultan, Pervez

doi:10.1016/j.ajog.2022.06.026

Cited by 21 publications

(15 citation statements)

References 122 publications

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“…Our results showed that in women with low-risk pregnancies, neuraxial analgesia was significantly associated with an increased incidence of mild maternal fever, which was in line with previous studies ( 2 , 15 ). In fact, the etiology of epidural-related maternal fever remains elusive and the sterile inflammation process was considered to be a possible mechanism ( 17 ). A randomized controlled trial with prophylactic antibiotics before epidural analgesia showed no difference in the rate of maternal fever between groups, supporting the non-infectious inflammation hypothesis of epidural fever ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of neuraxial labor analgesia on intrapartum maternal fever in full-term pregnancy and its influence on birth outcomes

Zhang

Deng

et al. 2023

Front. Med.

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IntroductionThis study aimed to explore the relationship between neuraxial labor analgesia and intrapartum fever and to demonstrate the influence of maternal fever on perinatal outcomes within 6 weeks after birth.MethodsThis was a secondary analysis of a multicenter prospective cohort study that enrolled women with single- and full-term cephalic pregnancy in northern China. Intrapartum maternal fever was defined as the highest axillary temperature during labor ≥37.5°C. Data on baseline characteristics, maternal variables, and neonatal outcomes were all collected. The association between neuraxial labor analgesia and intrapartum maternal fever was analyzed with logistic regression models, and the cutoff point was identified by the receiver operating characteristic curve.ResultsOf 577 parturients, 74 (12.8%) developed intrapartum fever. Neuraxial analgesia was associated with an increased risk of maternal intrapartum fever with or without adjusting for confounding factors (adjusted OR = 2.68; 95% CI: 1.32–5.47; p = 0.007). Further analysis showed that neuraxial analgesia of <5 h did not increase the risk of intrapartum fever compared with no analgesia (OR = 1.52; 95% CI: 0.63–3.64; p = 0.35), and longer neuraxial labor analgesia time (over 5 h) significantly increased the risk of fever (OR = 3.38; 95% CI: 1.63–7.01; p = 0.001). Parturients with intrapartum fever suffered more maternal adverse outcomes compared with those without fever (p< 0.001). Neonates of women with intrapartum fever had slightly higher rates of composite adverse neonatal outcomes compared with those without fever; however, the difference was not statistically significant (p = 0.098).ConclusionIn women with low-risk pregnancies, a longer time of neuraxial labor analgesia was associated with an increased risk of intrapartum maternal fever. Intrapartum fever was related to adverse maternal outcomes but did not significantly affect neonatal outcomes within 6 weeks after delivery.

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Section: Discussionmentioning

confidence: 99%

Effects of neuraxial labor analgesia on intrapartum maternal fever in full-term pregnancy and its influence on birth outcomes

Zhang

Deng

et al. 2023

Front. Med.

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“…29 Challenges remain in the discrimination of infectious fever and other causes of noninfectious causes of temperature elevation (such as epidural-related maternal fever and misoprostol use). 30,31 Due to the potential adverse outcomes with untreated infection, each incidence of fever should be thoroughly evaluated and treated when indicated. 7.…”

Section: Recognize and Treat Infection Early Tomentioning

confidence: 99%

Alliance for Innovation on Maternal Health

Bauer,

Albright,

Prabhu

et al. 2023

Obstetrics &Amp; Gynecology

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Sepsis in obstetric care is one of the leading causes of maternal death in the United States, with Black, Asian/Pacific Islander, and American Indian/Alaska Native obstetric patients experiencing sepsis at disproportionately higher rates. State maternal mortality review committees have determined that deaths are preventable much of the time and are caused by delays in recognition, treatment, and escalation of care. The “Sepsis in Obstetric Care” patient safety bundle provides guidance for health care teams to develop coordinated, multidisciplinary care for pregnant and postpartum people by preventing infection and recognizing and treating infection early to prevent progression to sepsis. This is one of several core patient safety bundles developed by AIM (the Alliance for Innovation on Maternal Health) to provide condition- or event-specific clinical practices that should be implemented in all appropriate care settings. As with other bundles developed by AIM, the “Sepsis in Obstetric Care” patient safety bundle is organized into five domains: Readiness, Recognition and Prevention, Response, Reporting and Systems Learning, and Respectful, Equitable, and Supportive Care. The Respectful, Equitable, and Supportive Care domain provides essential best practices to support respectful, equitable, and supportive care to all patients. Further health equity considerations are integrated into the elements of each domain.

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“…ERMF is a widely recognized outcome with a reported incidence of 15% to 25% 1 . The study by Cartledge and colleagues is a systematic review and meta-analysis aimed to evaluate preventative strategies to reduce the incidence of EMRF.…”

Section: Commentmentioning

confidence: 99%

“…ERMF is a widely recognized outcome with a reported incidence of 15% to 25%. 1 The study by Cartledge and colleagues is a systematic review and meta-analysis aimed to evaluate preventative strategies to reduce the incidence of EMRF. This represents the first systematic review to evaluate and compare all available RCTs in preventative strategies for reducing ERMF.…”

Section: Commentmentioning

confidence: 99%

Interventions for the Prevention or Treatment of Epidural-related Maternal Fever: A Systematic Review and Meta-analysis

Cartledge,

Hind,

Bradburn

et al. 2023

Obstetric Anesthesia Digest

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(British Journal of Anaesthesia. 2022;129:567e580) Epidural-related maternal fever (ERMF) occurs in 15% to 25% of laboring women who receive analgesia. ERMF is not seen in non-pregnant or pregnant women who are not in labor. The cause behind ERMF is not yet understood. There have been studies on a number of preventative interventions for ERMF. This systematic review aimed to compare the effectiveness of proposed interventions, primarily in terms of the incidence of ERMF, and secondarily, by comparing the incidence of neonatal sepsis evaluation and neonatal admission to level 2 care.

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Epidural-related maternal fever: incidence, pathophysiology, outcomes, and management

Cited by 21 publications

References 122 publications

Effects of neuraxial labor analgesia on intrapartum maternal fever in full-term pregnancy and its influence on birth outcomes

Effects of neuraxial labor analgesia on intrapartum maternal fever in full-term pregnancy and its influence on birth outcomes

Alliance for Innovation on Maternal Health

Interventions for the Prevention or Treatment of Epidural-related Maternal Fever: A Systematic Review and Meta-analysis

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