Maternal Pyrexia Associated With the Use of Epidural Analgesia in Labour

Fusi, Luca; Maresh, MichaelJ.A.; Steer, PJ; Beard, R. W.

doi:10.1016/s0140-6736(89)92341-6

Cited by 222 publications

(66 citation statements)

References 9 publications

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“…It is now well established that 11%–19% of patients with epidural anesthesia/analgesia develop hyperthermia [23, 97–104]. The mechanism responsible for fever in these cases is unknown, but accumulating evidence suggests it is of an inflammatory nature [103–108].…”

Section: Discussionmentioning

confidence: 99%

Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques

Romero¹,

Miranda²,

Kusanovic³

et al. 2015

Journal of Perinatal Medicine

212

216

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Introduction The objectives of this study were: 1) to determine the amniotic fluid (AF) microbiology of patients with the diagnosis of clinical chorioamnionitis at term using both cultivation and molecular techniques; and 2) to examine the relationship between intra-amniotic inflammation with and without microorganisms and placental lesions consistent with acute AF infection. Methods The AF samples obtained by transabdominal amniocentesis from 46 women with clinical signs of chorioamnionitis at term were analyzed using cultivation techniques (for aerobic and anerobic bacteria as well as genital mycoplasmas) and broad-range polymerase chain reaction (PCR) coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). The frequency of microbial invasion of the amniotic cavity (MIAC), intra-amniotic inflammation [defined as an AF interleukin 6 (IL-6) concentration ≥ 2.6ng/mL], and placental lesions consistent with acute AF infection (acute histologic chorioamnionitis and/or acute funisitis) were examined according to the results of AF cultivation and PCR/ESI-MS as well as AF IL-6 concentrations. Results 1) Culture identified bacteria in AF from 46% (21/46) of the participants, whereas PCR/ESI-MS was positive formicroorganisms in 59% (27/46) – combining these two tests, microorganisms were detected in 61% (28/46) of patients with clinical chorioamnionitis at term. Eight patients had discordant test results; one had a positive culture and negative PCR/ESI-MS result, whereas seven patients had positive PCR/ESI-MS results and negative cultures. 2) Ureaplasma urealyticum (n = 8) and Gardnerella vaginalis (n = 10) were the microorganisms most frequently identified by cultivation and PCR/ESI-MS, respectively. 3) When combining the results of AF culture, PCR/ESI-MS and AF IL-6 concentrations, 15% (7/46) of patients did not have intra-amniotic inflammation or infection, 6.5% (3/46) had only MIAC, 54% (25/46) had microbial-associated intra-amniotic inflammation, and 24% (11/46) had intra-amniotic inflammation without detectable microorganisms. 4) Placental lesions consistent with acute AF infection were significantly more frequent in patients with microbial-associated intra-amniotic inflammation than in those without intra-amniotic inflammation [70.8% (17/24) vs. 28.6% (2/7); P = 0.04]. Conclusion Microorganisms in the AF were identified in 61% of patients with clinical chorioamnionitis at term; 54% had microbial-associated intra-amniotic inflammation, whereas 24% had intra-amniotic inflammation without detectable microorganisms.

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Section: Discussionmentioning

confidence: 99%

Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques

Romero¹,

Miranda²,

Kusanovic³

et al. 2015

Journal of Perinatal Medicine

212

216

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“…Increased pyrexia is known to be associated with epidural use 6 . Given the relative importance of fever in the diagnosis of clinical chorioamnionitis, it is not surprising that epidural use and an associated fever may have a confounding effect on clinical diagnosis of chorioamnionitis 7 .…”

Section: Disease Descriptionmentioning

confidence: 99%

Current Management and Long-term Outcomes Following Chorioamnionitis

Johnson

Farzin

Burd

2014

Obstetrics and Gynecology Clinics of North America

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“…This illustrates the fact that chorioamnionitis is primarily a fetal disease and not a maternal disease, therefore signs and symptoms may not be consistently present in the mother. Conversely, maternal pyrexia often occurs in women with epidural analgesia, in the absence of histopathological evidence of chorioamnionitis …”

Section: Introductionmentioning

confidence: 99%

Intrapartum cardiotocography patterns observed in suspected clinical and subclinical chorioamnionitis in term fetuses

Galli

Dall’Asta

Whelehan

et al. 2019

J of Obstet and Gynaecol

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Aim: To evaluate the cardiotocography (CTG) features observed in suspected intrapartum chorioamnionitis in term fetuses according to the recently suggested criteria for the pathophysiological interpretation of the fetal heart rate and their correlation with perinatal outcomes. Methods: Retrospective analysis of nonconsecutive CTG traces. 'CTG chorioamnionitis' was diagnosed either based on a persistent rise in the baseline for the given gestation or on a persistent increase in the baseline fetal heart rate during labor >10% without preceding CTG signs of hypoxia and in the absence of maternal pyrexia. Perinatal outcomes were compared among cases with no sign of chorioamnionitis, in those with only CTG features suspicious for chorioamnionitis and in those who developed clinical chorioamnionitis. Results: Two thousand one hundred and five CTG traces were analyzed. Of these, 356 fulfilled the criteria for "CTG chorioamnionitis". Higher rates of Apgar <7 at 1 and 5 min (21.6% vs 9.0% and 9.8% vs 2.0%, respectively, P < 0.01 for both) and lower umbilical artery pH (7.14 AE 0.11 vs 7.19 AE 0.11, P < 0.01) and an over fivefold higher rate of neonatal intensive care unit admission (16.6% vs 2.9%, P < 0.01) were noted in the 'CTG chorioamnionitis' group. Differences in the incidence of abnormal CTG patterns were noted between cases who eventually had clinical evidence of chorioamnionitis (89/356) and those showing CTG features suspicious for chorioamnionitis in the absence of clinical evidence of chorioamnionitis (267/356). Conclusion: Intrapartum CTG features of suspected chorioamnionitis are associated with adverse perinatal outcomes.

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Maternal Pyrexia Associated With the Use of Epidural Analgesia in Labour

Cited by 222 publications

References 9 publications

Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques

Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques

Current Management and Long-term Outcomes Following Chorioamnionitis

Intrapartum cardiotocography patterns observed in suspected clinical and subclinical chorioamnionitis in term fetuses

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