Maternal fever in labor: etiologies, consequences, and clinical management

Goetzl, Laura

doi:10.1016/j.ajog.2022.11.002

Cited by 26 publications

(12 citation statements)

References 78 publications

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“…The association between maternal fever in labor and neuraxial analgesia has been supported in multiple studies. 1,2 A recent review by Laura Goetzl, M.D. outlined possible etiologies, mechanisms of fever, consequences, and clinical management.…”

Section: Commentmentioning

confidence: 99%

“…outlined possible etiologies, mechanisms of fever, consequences, and clinical management. 1 Key factors that influence the risk of a laboring patient to develop fever include nulliparity, ethnicity (Hispanic and Asian or Pacific Islanders), and standard-dose oxytocin protocols compared with high-dose protocols (the development of clinical chorioamnionitis was lower in the high-dose oxytocin arm, perhaps due to a shorter labor). Moreover, duration of exposure to epidural analgesia or length of labor in unmedicated women remains a risk factor for intrapartum fever.…”

Section: Commentmentioning

confidence: 99%

“…Moreover, duration of exposure to epidural analgesia or length of labor in unmedicated women remains a risk factor for intrapartum fever. 1 There is no evidence that the rates of fever or exposure to inflammatory cytokines are altered with traditional epidural when compared with combined spinal epidural or continuous spinal analgesia nor with patient-administered epidural boluses. 3 No specific neuraxial technique has been recommended to reduce maternal fever or fetal inflammation.…”

Section: Commentmentioning

confidence: 99%

“…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.…”

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confidence: 99%

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Interleukin-1 Receptor Antagonist, Mode of Analgesia and Risk of Cesarean Delivery After Onset of Labor: A Mendelian Randomization Analysis

Ackland,

Van Duijvenboden,

Abbott

et al. 2023

Obstetric Anesthesia Digest

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(Br J Anaesth. 2022;128:89–97) Inflammation during labor can cause a host of complications that can in turn lead to emergency cesarean delivery due to increased risks to both mother and child. The body has natural responses to inflammation, one of which is the release of an anti-inflammatory cytokine, an interleukin-1 receptor antagonist (IL-1ra). The gene that encodes the expression of IL-1ra has 2 upstream alleles that increase mRNA expression and IL-1ra concentration. Previously in similar situations where genes have been identified and associated, Mendelian randomization techniques have been able to show causal relationships between the genes and observable outcomes.

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Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

mentioning

confidence: 99%

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Interleukin-1 Receptor Antagonist, Mode of Analgesia and Risk of Cesarean Delivery After Onset of Labor: A Mendelian Randomization Analysis

Ackland,

Van Duijvenboden,

Abbott

et al. 2023

Obstetric Anesthesia Digest

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“…3 No specific neuraxial technique has been recommended to reduce maternal fever or fetal inflammation. 1 Several studies have evaluated the effects of local anesthetic medications on inflammatory pathways. Local anesthetics modulate leukocyte adhesion to the endothelium, shape change, phagocytosis, and release of proinflammatory mediators.…”

Section: Commentmentioning

confidence: 99%

Effect of Continuous Infusion of a Subhypnotic Dose of Propofol on Nausea and Vomiting after Carboprost Administration at Cesarean Delivery: A Randomized, Double-blind, Placebo-controlled Trial

Yanmei,

Ruihan,

Jinxiang

et al. 2023

Obstetric Anesthesia Digest

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(Int J Gynecol Obstet. 2022;157:283–288) Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality. Carboprost is a 15-methyl F2a prostaglandin that induces uterine contractions and is recommended for PPH treatment. Carboprost has adverse side effects, the most prominent being nausea and vomiting. Propofol, when used at its subhypnotic dose, is known for reducing nausea and vomiting after chemotherapy treatment. This study aimed to show whether a steady administration of a subhypnotic dose of propofol prevents nausea and vomiting after carboprost is administered during cesarean delivery (CD).

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Epidural Analgesia During Labor and Neonatal Hypoxic-Ischemic Encephalopathy

Cornet,

Kuzniewicz,

Scheffler

et al. 2024

JAMA Netw Open

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ImportanceEpidural analgesia is used by approximately 70% of birthing persons in the US to alleviate labor pain and is a common cause of elevated temperature in the birthing parent during labor, which, in turn, is associated with adverse neonatal outcomes such as hypoxic-ischemic encephalopathy (HIE).ObjectiveTo determine whether epidural analgesia is associated with increased risk of HIE after adjusting for the birthing person’s maximal temperature before epidural placement and for the propensity to get an epidural.Design, Setting, and ParticipantsThis retrospective, population-based cohort study was conducted at 15 Kaiser Permanente Northern California hospitals. Participants included singleton neonates born at 35 weeks’ or later gestational age between 2012 and 2019. Elective cesarean deliveries and deliveries within 2 hours of hospital admission were excluded. Data analysis was performed from November 2022 to June 2024.ExposureThe primary exposure was epidural analgesia during labor.Main Outcomes and MeasuresThe primary outcome was HIE, defined as the presence of both neonatal acidosis (ie, pH &lt;7 or base deficit ≥10) and encephalopathy. The presence and timing of epidural analgesia and demographic, pregnancy, and labor characteristics were extracted from electronic medical records. A propensity score for receiving epidural analgesia was created including demographic variables and comorbidities predating epidural placement. Logistic regression was used to evaluate the association between epidural analgesia and HIE, adjusting for maximal birthing parent’s temperature before epidural placement and the propensity for receiving an epidural.ResultsAmong 233 056 infants born at 35 weeks’ or later gestational age by vaginal or unplanned cesarean delivery after at least 2 hours of in-hospital labor, 177 603 (76%) were exposed to epidural analgesia and 439 (0.19%) had HIE. On unadjusted analysis, epidural analgesia was associated with an increased risk of maximal temperature greater than 38 °C during labor (risk ratio [RR], 8.58; 95% CI, 8.06-9.14). Each degree increase in maximal temperature during labor was associated with nearly triple the odds of HIE (odds ratio [OR], 2.82; 95% CI, 2.51-3.17). However, there was no significant association between epidural analgesia and the risk of HIE either on crude (RR, 1.21; 95% CI, 0.96-1.53) or adjusted (adjusted OR, 0.93; 95% CI, 0.73-1.17) analyses.Conclusions and RelevanceIn this cohort study including more than 230 000 parent-infant dyads, epidural analgesia was associated with increased maximal temperature during labor, a known risk factor for HIE. However, epidural analgesia was not associated with increased odds of HIE.

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Maternal fever in labor: etiologies, consequences, and clinical management

Cited by 26 publications

References 78 publications

Interleukin-1 Receptor Antagonist, Mode of Analgesia and Risk of Cesarean Delivery After Onset of Labor: A Mendelian Randomization Analysis

Interleukin-1 Receptor Antagonist, Mode of Analgesia and Risk of Cesarean Delivery After Onset of Labor: A Mendelian Randomization Analysis

Effect of Continuous Infusion of a Subhypnotic Dose of Propofol on Nausea and Vomiting after Carboprost Administration at Cesarean Delivery: A Randomized, Double-blind, Placebo-controlled Trial

Epidural Analgesia During Labor and Neonatal Hypoxic-Ischemic Encephalopathy

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