Hyperthermia after epidural analgesia in obstetrics

Mullington, C J; Malhotra, Surbhi

doi:10.1016/j.bjae.2020.08.004

Cited by 7 publications

(11 citation statements)

References 23 publications

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Section: Methodsmentioning

confidence: 99%

“…Any elevated maternal temperature during labor is referred to as intrapartum hyperthermia [ 20 ]. Because fever suggests an inflammatory process, which has not been proved, hyperthermia is the recommended word [ 20 ]. A commonly used definition of intrapartum hyperthermia is: ‘a core temperature during labor of ≥ 38°C on one occasion or ≥ 37.5°C on two consecutive occasions two hours apart’ [ 20 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

“…Because fever suggests an inflammatory process, which has not been proved, hyperthermia is the recommended word [ 20 ]. A commonly used definition of intrapartum hyperthermia is: ‘a core temperature during labor of ≥ 38°C on one occasion or ≥ 37.5°C on two consecutive occasions two hours apart’ [ 20 , 21 ]. Epidural hyperthermia and intrapartum infection are the two main etiologies [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

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Laboratory markers to identify acute histological chorioamnionitis in febrile parturients undergoing epidural analgesia: a retrospective study

Xu,

Fan,

Zhang

et al. 2023

BMC Pregnancy Childbirth

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Background This study aimed to investigate the effect of the pathological staging of acute histological chorioamnionitis (HCA) on laboratory indicators and to conduct further studies to reassess the threshold values used by clinicians to identify acute HCA in febrile parturients undergoing epidural analgesia. Methods A retrospective study of febrile mothers receiving epidural analgesia at Nanjing Maternal and Child Health Care Hospital from January 1, 2018 to December 31, 2018. The participants were grouped by the progression of acute HCA, and the laboratory parameters were compared between groups. The ability of C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and monocyte-leukocyte ratio (M%), alone or in combination, to identify acute HCA in febrile parturients undergoing epidural analgesia was assessed using logistic regression and ROC curves. Results The area under the curve (AUC) of the best logistic regression model predicting HCA climbed to 0.706 (CRP + MLR). Maternal CRP, NLR, and MLR significantly and progressively increased with the progression of acute HCA (p < 0.0001). Based on the ROC curves, the following thresholds were selected to define increased laboratory indicators for identifying acute HCA: CRP ≥ 6.90 mg/L, NLR ≥ 11.93, and MLR ≥ 0.57. In addition, the AUC of the best logistic regression model predicting HCA ≥ stage 2 was 0.710, so these inflammatory markers were more precise in predicting HCA ≥ stage 2. Conclusion Increased CRP (≥ 6.90 mg/L), NLR (≥ 11.93), and MLR (≥ 0.57) may help clinicians to identify early potential acute HCA in febrile parturients receiving epidural analgesia and to monitor progression to optimize clinical treatment options. Trial registration The study was registered in the Chinese Clinical Trial Registry on November 24, 2021 (http://www.chictr.org.cn, ChiCTR2100053554).

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Laboratory markers to identify acute histological chorioamnionitis in febrile parturients undergoing epidural analgesia: a retrospective study

Xu,

Fan,

Zhang

et al. 2023

BMC Pregnancy Childbirth

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“…Various mechanisms have been proposed including thermoregulatory disruption by sympathetic blockade, systemic opioid administration dampening fever development in those who elect not to receive epidural, and more recently inflammatory processes. 6 Currently, the two main candidate mechanisms supported by research evidence are inhibition of cutaneous heat loss 7 and 'sterile' inflammation from exposure to continuous infusion of local anaesthetic mediated by elevation in proinflammatory cytokines, for example interleukin-6 (IL-6) at a cellular level. 4,8e10 A range of preventative interventions have been evaluated in the management of ERMF, based on different assumptions of the underlying mechanism, including intermittent administration of epidural analgesia, compared with continuous infusion, 11,12 to reduce local anaesthetic dose, prophylactic steroids, 13 and prophylactic paracetamol.…”

mentioning

confidence: 99%

“…Currently, the two main candidate mechanisms supported by research evidence are inhibition of cutaneous heat loss 7 and ‘sterile’ inflammation from exposure to continuous infusion of local anaesthetic mediated by elevation in pro-inflammatory cytokines, for example interleukin-6 (IL-6) at a cellular level. 4 , 8 , 9 , 10 …”

mentioning

confidence: 99%