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

Burgess, Angela; Katz, Justin; Moretti, Michael; Lakhi, Nisha

doi:10.1159/000453611

Cited by 54 publications

(50 citation statements)

References 37 publications

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“…A few studies have observed that women receiving epidural analgesia were at increased risk for intrapartum fever . Women with maternal pyrexia are more likely to receive antibiotics and undergo instrumental delivery and maternal pyrexia may also be associated with adverse neonatal outcomes including low Apgar scores, respiratory distress, hypotonia and neonatal seizures . However, another study suggested that epidural fever may be a benign rise in temperature not associated with neonatal neurological consequences .…”

Section: Introductionmentioning

confidence: 99%

A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes

Yin

2019

J of Obstet and Gynaecol

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Aim: To explore the impact of epidural analgesia on maternal and neonatal outcomes, especially the relation between epidural analgesia and intrapartum fever. Methods: A retrospective cohort study was conducted in a tertiary hospital for all deliveries from November 2017 to December 2017. A total of 506 women were divided into epidural and non-epidural group by whether to receive analgesia or not. Univariate and multivariate analyses were performed with P < 0.05 as significant. Results: Epidural analgesia was associated with higher risk of maternal intrapartum fever (relative risk [RR] = 3.28, 95% confidence interval, 1.55-6.95), more intravenous use of antibiotics (36.66% vs 17.04%, P<0.001), longer time of second stage (58.55 AE 33.75 vs 47.39 AE 28.36 min，P = 0.001) and longer total duration of labor (790.32 AE 433.71 vs 461.33 AE 270.39 min，P<0.001), but had no influence on mode of delivery, the amount of post-partum hemorrhage or hospital stay after delivery and all the neonatal outcomes we studied. Further time effect analysis found that epidural analgesia less than 6 h did not increase the risk of intrapartum fever (RR = 1.73, P = 0.15), however, when epidural analgesia lasted over 6 h, it significantly increased the risk of fever (RR = 5.23, P<0.001) but did not increase more adverse outcomes. Conclusion: Having epidural anesthesia 6 h or more increases the risk of developing fever, but the prognosis of mothers and children is less affected.

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Section: Introductionmentioning

confidence: 99%

A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes

Yin

2019

J of Obstet and Gynaecol

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“…In a study by Curtin et al, histological chorioamnionitis (OR = 3.18; 95% CI, 2.04–4.95) as well as epidural analgesia (OR = 3.40; 95% CI, 1.70–6.81) were independently associated with intrapartum fever at term 2 . Meanwhile, in a retrospective study by Burgess et al ( n = 360), there were associations between intrapartum fever above 38.0°C and longer duration of labor (OR 3.59; 95% CI, 1.97–6.55), and longer duration of ROM (OR = 4.51; 95% CI, 2.24–9.09) 22 . Our finding that a severe stage of acute chorioamnionitis and funisitis, longer duration of ROM, and a higher postpartum WBC count associated with the degree of intrapartum fever favors this maternal‐fetal inflammation hypothesis.…”

Section: Discussionmentioning

confidence: 93%

Degree of intrapartum fever and associated factors: Three group analysis of no fever, borderline and overt fever

Kim

Hong

Kwon

et al. 2021

J of Obstet and Gynaecol

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Aim Previous studies analyzing intrapartum fever by dichotomization of fever just above 38.0°C or not may lead to overlook clinical significance of borderline fever. We aimed to investigate the maternal baseline and intrapartum characteristics, neonatal outcomes, and inflammatory placental pathology in relation to the degree of intrapartum fever by three group analysis. Methods We performed a retrospective analysis of consecutive singleton deliveries between 370/7 to 410/7 weeks divided into three groups based on the peak body temperature during labor: No fever (< 37.5°C), borderline fever (≥ 37.5°C and < 38.0°C), and overt fever (≥ 38.0°C). Maternal and intrapartum characteristics, neonatal outcomes, and inflammatory placental pathology were compared by trend analysis, intergroup difference analysis, and multivariable analysis. Results The degree of intrapartum fever was significantly associated with younger maternal age, nulliparity, longer duration of rupture of membrane, and epidural analgesia (p < 0.001). And the incidence of neonatal proven sepsis and mortality were not significantly different among the groups. The degree of intrapartum fever was associated with the stage of acute chorioamnionitis and funisitis (p < 0.001). Multivariate analysis revealed that the association with epidural analgesia was stronger in borderline fever than overt fever (adjusted odds ratio [95% confidence interval], borderline fever = 18.487 [11.447–29.857]; overt fever = 11.068 [4.874–25.133]) after controlling for maternal age, parity, induction or augmentation, duration of ROM, birth weight, and meconium staining. Conclusion Our data support that both epidural analgesia and inflammation of the placenta may contribute to the development of intrapartum fever at term.

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“…Also, our research results showed that the rst stage of labor was longer and the number of vaginal examinations was higher in women who received induction than those who did not (Table 2). Burgess et al [25] proved that the duration of the rst stage of labor and the number of vaginal examinations were signi cantly associated with increased risk of maternal fever. This association was probably caused by an increased risk of chorioamnionitis, and a long duration of the rst stage of labor may sustain an in ammatory process that may result in the temperature elevation in those patients.…”

Section: Discussionmentioning

confidence: 99%

Labor Induction And The Incidence of Intrapartum Maternal Fever In Epidural Labor Analgesia: A Retrospective Case-Control Study

et al. 2020

Preprint

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Background: To assess the influence of labor induction on the intrapartum maternal fever in epidural labor analgesia and to determine its association with intrapartum fever.Methods: A retrospective case-control study was performed during 2016–2018 in a first-class tertiary hospital. All patients who received epidural labor analgesia were allocated into either case (parturients who received labor induction and had intrapartum fever) or control (parturients who did not receive labor induction but had intrapartum fever) groups. Maternal demographic and intrapartum data, epidural infusions records, and neonatal short-term outcome were studied.Results: A total of 710 epidural labor analgesia occurred during the study period and 119 (16.76%) women had intrapartum fever. Intrapartum fever occurred in 66 (25.68%) women who received labor induction and in 53 (11.70%) who did not. After correction for confounding factors, labor induction (OR 2.818, 95% CI, 1.778–4.467, P<0.001), number of vaginal examinations (OR 1.242, 95% CI, 1.048–1.471, P=0.012), baseline maternal temperature (OR 6.702, 95% CI, 2.065–21.755, P=0.002), admission white blood cell count (OR 1.171, 95% CI, 1.052–1.303, P=0.004), and neonatal birth weight (OR 3.015, 95% CI, 1.739–5.227, P<0.001) were risk factors for intrapartum maternal fever during epidural labor analgesia.Conclusion: Labor induction was significantly associated with an increased risk of intrapartum maternal fever during epidural labor analgesia.

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

Cited by 54 publications

References 37 publications

A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes

A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes

Degree of intrapartum fever and associated factors: Three group analysis of no fever, borderline and overt fever

Labor Induction And The Incidence of Intrapartum Maternal Fever In Epidural Labor Analgesia: A Retrospective Case-Control Study

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