Intrapartum fever, epidural analgesia and histologic chorioamnionitis

Curtin, William M.; Katzman, Philip J.; Florescue, Heather; Metlay, Leon A.; Ural, Serdar H.

doi:10.1038/jp.2014.235

Cited by 40 publications

(34 citation statements)

References 30 publications

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“…It is still unclear how the timing of antibiotic administration affects outcomes that are not associated with maternal sepsis. However, intrapartum antibiotic administration can also have serious consequences to both the mother and neonate [6]. This can include NICU admission, an unnecessary work-up for sepsis, and antimicrobial treatment of the newborn, as was demonstrated in our study cohort.…”

Section: Discussionmentioning

confidence: 71%

“…This can include NICU admission, an unnecessary work-up for sepsis, and antimicrobial treatment of the newborn, as was demonstrated in our study cohort. Exposure to the NICU environment is also associated with increased costs, as well as increased risk of exposure to multi-drug resistant organisms [6]. Infants in NICU were also separated from their mothers, which may have resulted in consequences related to infant–mother bonding and successful breastfeeding [6].…”

Section: Discussionmentioning

confidence: 99%

“…Exposure to the NICU environment is also associated with increased costs, as well as increased risk of exposure to multi-drug resistant organisms [6]. Infants in NICU were also separated from their mothers, which may have resulted in consequences related to infant–mother bonding and successful breastfeeding [6]. Evidence also suggests that exposure to intrapartum antibiotics may affect the infant gut micro-flora and increase susceptibility to late-onset bacterial infections in infancy [27–29].…”

Section: Discussionmentioning

confidence: 99%

“…Both infectious and noninfectious causes of maternal fever have been linked to transient adverse neonatal complications including low Apgar scores, respiratory distress, hypotonia, and neonatal seizures [1]. More importantly, the presence of maternal fever in labor is a strong risk factor for long-term neonatal developmental outcomes, including encephalopathy, cerebral palsy, and neonatal death [3, 6]. …”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Intrapartum Fever in Term Gestations and Associated Maternal and Neonatal Sequelae

Burgess

Katz

Moretti

et al. 2017

Gynecol Obstet Invest

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Aim: To determine factors associated with intrapartum fever and to examine associated maternal and neonatal outcomes. Methods: Retrospective study of patients between 36^0/7 and 42^0/7 gestational weeks who entered spontaneous or induced active labor and developed temperature ≥38°C; a similar group that did not develop fever were controls. Univariate and multivariate analyses were performed with p < 0.05 as significant. Results: Fifty-four febrile patients and 306 nonfebrile controls met inclusion criteria. Nulligravidity (45.8 vs. 77.8%, p < 0.001), length of first stage ≥720 min (OR 3.59, 95% CI 1.97-6.55, p < 0.001), length of second stage ≥120 min (OR 4.76, 95% CI 2.29-9.89, p < 0.001), membrane rupture ≥240 min (46.4 vs. 79.6%, p < 0.001), increasing number of vaginal exams (4 vs. 6, p < 0.001), oxytocin (44.8 vs. 63.0%, p = 0.014), and meperidine (14.7 vs. 35.2%, p < 0.001) were all associated with intrapartum fever. Associated morbidity included cesarean delivery (22.5 vs. 44.4%, p = 0.001), Apgar score <7 at 5 min (0.7 vs. 5.6%, p = 0.011), and neonatal intensive care unit admission (9.5 vs. 51.9%, p < 0.001). Conclusion: We have identified several noninfectious factors that are associated with intrapartum fever. Modification of risk factors may improve both maternal and neonatal outcomes.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Intrapartum Fever in Term Gestations and Associated Maternal and Neonatal Sequelae

Burgess

Katz

Moretti

et al. 2017

Gynecol Obstet Invest

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“…Intrapartum fever in women receiving epidural analgesia (EA) is associated with a higher risk of cesarean delivery and assisted ventilation in neonates, neonatal hypotonia, unnecessary neonatal antibiotic treatment, and even early-onset seizures [1][2][3][4]. Intrapartum fever is referred to as maternal temperature not less than 38°C (100.4°F) during labor [5].…”

Section: Introductionmentioning

confidence: 99%

Remifentanil patient-controlled versus epidural analgesia on intrapartum maternal fever: a systematic review and meta-analysis

Yao

Chen

et al. 2020

BMC Pregnancy Childbirth

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Background: Intravenous remifentanil patient-controlled analgesia (RPCA) is an alternative for epidural analgesia (EA) in labor pain relief. However, it remains unknown whether RPCA is superior to EA in decreasing the risk of intrapartum maternal fever during labor. Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was performed by searching PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from inception to April 2019. All randomized controlled trials (RCTs) investigating the risk of intrapartum maternal fever with RPCA compared with EA alone or EA in combination with spinal analgesia during labor were included. Results: A total of 825 studies were screened, and 6 RCTs including 3341 patients were identified. Compared with EA, RPCA was associated with a significantly lower incidence of intrapartum maternal fever (risk ratio [RR] 0.48, P = 0.02, I 2 = 49%) during labor analgesia. After excluding 2 trials via the heterogeneity analysis, there was no difference in the incidence of intrapartum fever between patients receiving RPCA and those receiving EA. Satisfaction with pain relief during labor was lower in the RPCA group than that in the EA group (− 10.6 [13.87, − 7.44], P < 0.00001, I 2 = 0%). The incidence of respiratory depression was significantly greater in the RPCA group than that in the EA group (risk ratio 2.86 [1.65, 4.96], P = 0.0002, I 2 = 58%). The incidence of Apgar scores < 7 at 5 min in the RPCA group was equivalent to that in the EA group. Conclusion: There is no solid evidence to illustrate that the incidence of intrapartum maternal fever is lower in patients receiving intravenous RPCA than in patients receiving EA.

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Study on perinatal‐related factors of maternity and newborn in parturients with intrapartum fever in part of Eastern China: A cross‐sectional study

Fan

Mao

et al. 2021

Clinical Laboratory Analysis

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Background Maternal intrapartum fever has a serious impact on mother and child. However, the corresponding study seems to be in short. Methods The role of inflammatory cells in patients who were diagnosed with intrapartum fever lived in part of Eastern China was evaluated. The obstetrics outcomes, complete blood cell count (CBC) and thereby converted neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio, monocyte to lymphocyte ratio (MLR), and vaginal secretion were compared in different groups. Results Prepartum values of white blood cell (WBC), red blood cell (RBC), and hemoglobin (Hb) were all a little higher in the febrile group than in the afebrile group, and postpartum WBC in the afebrile group was still higher while postpartum RBC and Hb were inferior to non‐fever maternity. Postpartum NLR and MLR were all higher in the fever group but not preferred overtly difference before delivery. Additionally, the comparison of WBC, RBC, Hb, platelets, neutrophils, and monocytes in prepartum and postpartum all showed significant differences. Conclusion The parturition could bring about the value change of CBC and intrapartum fever might aggravate or alleviate this change. Besides, the intrapartum fever might not be caused mainly by infection and the difference between bacteria and fungus could reflect in the CBC.

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Intrapartum fever, epidural analgesia and histologic chorioamnionitis

Abstract: Epidural analgesia and histologic chorioamnionitis were independent predictors of intrapartum fever. Modification of labor management may reduce the incidence of intrapartum fever.

Cited by 40 publications

References 30 publications

Risk Factors for Intrapartum Fever in Term Gestations and Associated Maternal and Neonatal Sequelae

Risk Factors for Intrapartum Fever in Term Gestations and Associated Maternal and Neonatal Sequelae

Remifentanil patient-controlled versus epidural analgesia on intrapartum maternal fever: a systematic review and meta-analysis

Study on perinatal‐related factors of maternity and newborn in parturients with intrapartum fever in part of Eastern China: A cross‐sectional study

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