Maternal and Newborn Outcomes Related to Maternal Warming During Cesarean Delivery

Fallis, Wendy M.; Hamelin, Kathy; Symonds, Jackie; Wang, Xikui

doi:10.1111/j.1552-6909.2006.00052.x

Cited by 69 publications

(73 citation statements)

References 32 publications

(39 reference statements)

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“…Personal intra-operative practice was variable, although all of those contacted would initiate some form of active temperature management after a mean (SD) volume of blood loss of 1282 (404) ml, length of surgery of 78 (24) Peri-operative hypothermia in non-obstetric cases has been found to increase wound infection rates and length of hospital stay [1], operative blood loss [2], and anaesthetic recovery time [3]. Few studies have included obstetric patients but although Caesarean sections are relatively short procedures, there is still a risk of hypothermia [4][5][6][7] and it has been recently suggested that all mothers should be warmed during Caesarean section [8]. We wished to ascertain which, if any, methods of warming were being used in the UK.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Warming of patients during Caesarean section: a telephone survey*

Woolnough¹,

Hemingway²,

Allam

et al. 2008

Anaesthesia

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SummaryWe contacted the duty obstetric anaesthetist in 219 of the 220 consultant-led maternity units in the UK (99.5%) and asked about departmental and individual practice regarding temperature management during Caesarean section. Warming during elective Caesarean section was routine in 35 units (16%). Intravenous fluid warmers were available in 213 units (97%), forced air warmers were available in 211 (96%) and warming mattresses were available in 42 (19%). Only 18 (8%) departments had specific guidelines for temperature management during Caesarean section. Personal intra-operative practice was variable, although all of those contacted would initiate some form of active temperature management after a mean (SD) volume of blood loss of 1282 (404) ml, length of surgery of 78 (24) Peri-operative hypothermia in non-obstetric cases has been found to increase wound infection rates and length of hospital stay [1], operative blood loss [2], and anaesthetic recovery time [3]. Few studies have included obstetric patients but although Caesarean sections are relatively short procedures, there is still a risk of hypothermia [4][5][6][7] and it has been recently suggested that all mothers should be warmed during Caesarean section [8]. We wished to ascertain which, if any, methods of warming were being used in the UK. MethodsWe identified consultant-led obstetric units from the Birth Choice website (http://www.birthchoiceuk.com) and one of two investigators contacted the duty obstetric anaesthetist by telephone during office hours (0800-1800, Monday to Friday) over a period of 5 months. If the anaesthetists were busy, we called back on another day and spoke to someone else. We asked, using a standard questionnaire, about the availability of different warming devices and departmental practice regarding temperature management during elective Caesarean section and in recovery. We also asked the individual anaesthetists about their personal thresholds for initiating temperature measurement and for active warming during Caesarean section. ResultsWe were able to contact anaesthetists in 219 of the 220 units listed (99.5%), the other unit not having dedicated obstetric anaesthetic cover during office hours. Twentyfour (11%) were senior house officers ⁄ specialist trainees (years 1-2), 89 (40%) were specialist registrars ⁄ specialist trainees (years 3-5), 65 (30%) were staff grades ⁄ associate specialists and 41 (19%) were consultants. The median (IQR [range]) time that the anaesthetists had spent in the department was 1.0 (0.3-6.0 [0.2-22.0]) years. None had been contacted by us at a previous unit before rotating to a new one.

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Section: Discussionmentioning

confidence: 99%

“…Few studies have included obstetric patients but although Caesarean sections are relatively short procedures, there is still a risk of hypothermia [4][5][6][7] and it has been recently suggested that all mothers should be warmed during Caesarean section [8]. We wished to ascertain which, if any, methods of warming were being used in the UK.…”

mentioning

confidence: 99%

Warming of patients during Caesarean section: a telephone survey*

Woolnough¹,

Hemingway²,

Allam

et al. 2008

Anaesthesia

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“…The rectum was selected as the site for body temperature measurement because of the difficulties and hazards associated with direct tympanic temperature measurement (1,15,16) associated with ear-based temperatures (1,(17)(18)(19)(20). Maternal rectal temperature was measured three times, just before anesthesia, at the beginning of operation and at delivery.…”

Section: Measurementsmentioning

confidence: 99%

“…However, all anesthetic drugs profoundly impair these mechanisms. Because of the core-to-peripheral redistribution of body heat that follows the induction of anesthesia, all patients are at risk for hypothermia (1).…”

mentioning

confidence: 99%

“…However, despite the shorter duration of anesthesia, the potential for mild maternal hypothermia still exists in both methods, and consequently a noticeable effect can also be expected on newborn body temperature (1,(11)(12)(13). Concomitant effects of newborn hypothermia may be seen in the physical and metabolic status of the infant at birth and in the immediate postnatal period (14).…”

mentioning

confidence: 99%

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The effect of epidural and general anesthesia on newborn rectal temperature at elective cesarean section

Yentur

Topçu

Ekici

et al. 2009

Braz J Med Biol Res

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Both epidural and general anesthesia can impair thermoregulatory mechanisms during surgery. However, there is lack of information about the effects of different methods of anesthesia on newborn temperature. The purpose of this study was to determine whether there are differences in newborn rectal temperature related to type of anesthesia. Sixty-three pregnant women were randomly assigned to receive general or epidural anesthesia. Maternal core temperature was measured three times with a rectal probe just before anesthesia, at the beginning of surgery and at delivery. In addition, umbilical vein blood was sampled for pH. The rectal temperatures of the babies were recorded immediately after delivery, and Apgar scores were determined 1, 5, and 10 min after birth. The duration of anesthesia and the volume of intravenous fluid given during the procedure (833 ± 144 vs 420 ± 215 mL) were significantly higher in the epidural group than in the general anesthesia group (P < 0.0001). Maternal rectal temperatures were not different in both groups at all measurements. In contrast, newborn rectal temperatures were lower in the epidural anesthesia group than in the general anesthesia group (37.4 ± 0.3 vs 37.6 ± 0.3°C; P < 0.05) immediately after birth. Furthermore, the umbilical vein pH value (7.31 ± 0.05 vs 7.33 ± 0.01; P < 0.05) and Apgar scores at the 1st-min measurement (8.0 ± 0.9 vs 8.5 ± 0.7; P < 0.05) were lower in the epidural anesthesia group than in the general anesthesia group. Since epidural anesthesia requires more iv fluid infusion and a longer time for cesarean section, it involves a risk of a mild temperature reduction for the baby which, however, did not reach the limits of hypothermia.

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Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants

McCall

Alderdice

Halliday

et al. 2008

Cochrane Database of Systematic Reviews

105

115

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Plastic wraps or bags, skin-to-skin care and transwarmer mattresses all keep preterm infants warmer, leading to higher temperatures on admission to neonatal units and less hypothermia. Given the low NNT, consideration should be given to using these interventions in the delivery suite. However, the small numbers of infants and studies and the absence of long-term follow-up mean that firm recommendations for clinical practice cannot be given. There is a need to conduct large, high quality randomised controlled trials looking at long-term outcomes.

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Maternal and Newborn Outcomes Related to Maternal Warming During Cesarean Delivery

Cited by 69 publications

References 32 publications

Warming of patients during Caesarean section: a telephone survey*

Warming of patients during Caesarean section: a telephone survey*

The effect of epidural and general anesthesia on newborn rectal temperature at elective cesarean section

Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants

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