The influence of anaesthetic techniques and type of delivery on peripartum serum interleukin‐6 concentrations

Jongh, Raf F De; Bosmans, Eugène; Puylaert, Martine; Ombelet, Willem; Vandeput, H.; Berghmans, R.; Maes, Michaël; Heylen, R.

doi:10.1111/j.1399-6576.1997.tb04800.x

Cited by 55 publications

(30 citation statements)

References 35 publications

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“…12 De Jongh et al 13 have also reported a relationship between epidural analgesia and increased maternal levels of IL-6. The mechanism through which epidural analgesia may trigger cytokine production during labor is not clear.…”

Section: Commentmentioning

confidence: 99%

Prophylactic Acetaminophen Does Not Prevent Epidural Fever in Nulliparous Women: A Double-Blind Placebo-Controlled Trial

et al. 2004

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OBJECTIVE:Epidural analgesia is associated with a four-to five-fold increase in noninfectious maternal fever in nulliparous women. Fever prophylaxis may safely reduce both unnecessary neonatal sepsis evaluations and the potential effect of fever on the fetus. STUDY DESIGN:We performed a randomized double-blind placebo-controlled study. Immediately after epidural placement, full-term nulliparas with a temperature of <99.51F received acetaminophen 650 mg or placebo, per rectum, every 4 hours. Tympanic membrane temperatures were measured hourly. Our power to detect an effect of acetaminophen treatment on maternal temperature over time was 90%. RESULTS:In all, 21 subjects were randomized to each arm. Treatment with acetaminophen did not impact maternal temperature curves. Fever >100.41F was identical in the acetaminophen and placebo groups (23.8%, p ¼ 1.0). Neonatal surveillance blood cultures did not reveal occult infection. CONCLUSIONS:Acetaminophen prophylaxis prevented neither maternal hyperthermia nor fever secondary to epidural analgesia, suggesting that the mechanism underlying fever does not include centrally mediated perturbations of maternal thermoregulation.

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Section: Commentmentioning

confidence: 99%

Prophylactic Acetaminophen Does Not Prevent Epidural Fever in Nulliparous Women: A Double-Blind Placebo-Controlled Trial

et al. 2004

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Section: Figurementioning

confidence: 99%

“…Our recent work, 10 as well that of others, [25][26][27] suggests an inflammatory response accompanying epidural-related fever. Studies have linked epidural use with elevated maternal serum levels of interleukin (IL)-6 25 and a higher monocyte production of IL-1b and IL-6 in the newborn. 26 Goetzl et al 27 found that in the absence of neonatal infection, intrapartum epidural-related fever was associated with elevation of both maternal and fetal serum levels of IL-6 compared with women receiving epidural who did not develop fever.…”

Section: Figurementioning

confidence: 99%

Intrapartum Temperature Elevation, Epidural Use, and Adverse Outcome in Term Infants

Greenwell¹,

Wyshak²,

Ringer³

et al. 2012

Obstetrical &Amp; Gynecological Survey

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WHAT'S KNOWN ON THIS SUBJECT: Previous observational studies and randomized trials have reported an association between the use of epidural analgesia for pain relief in labor and intrapartum maternal fever. Studies have also reported an increase in adverse neonatal outcomes with intrapartum maternal fever.WHAT THIS STUDY ADDS: Among low-risk women receiving epidural analgesia, intrapartum maternal temperature .99.5°F was associated with adverse neonatal outcomes, with the rate of adverse outcomes increasing directly with maximum maternal temperature. Without temperature elevation, epidural use was not associated with adverse neonatal outcomes. abstract OBJECTIVES: To examine the association of intrapartum temperature elevation with adverse neonatal outcome among low-risk women receiving epidural analgesia and evaluate the association of epidural with adverse neonatal outcome without temperature elevation. METHODS:We studied all low-risk nulliparous women with singleton pregnancies $37 weeks delivering at our hospital during 2000, excluding pregnancies where infants had documented sepsis, meningitis, or a major congenital anomaly. Neonatal outcomes were compared between women receiving (n = 1538) and not receiving epidural analgesia (n = 363) in the absence of intrapartum temperature elevation (#99.5°F) and according to the level of intrapartum temperature elevation within the group receiving epidural (n = 2784). Logistic regression was used to evaluate neonatal outcome while controlling for confounders. RESULTS: Maternal temperature .100.4°F developed during labor in 19.2% (535/2784) of women receiving epidural compared with 2.4% (10/425) not receiving epidural. In the absence of intrapartum temperature elevation (#99.5°F), no significant differences were observed in adverse neonatal outcomes between women receiving and not receiving epidural. Among women receiving epidural, a significant linear trend was observed between maximum maternal temperature and all neonatal outcomes examined including hypotonia, assisted ventilation, 1-and 5-min Apgar scores ,7, and early-onset seizures. In regression analyses, infants born to women with fever .101°F had a two-to sixfold increased risk of all adverse outcomes examined. CONCLUSIONS:The proportion of infants experiencing adverse outcomes increased with the degree of epidural-related maternal temperature elevation. Epidural use without temperature elevation was not associated with any of the adverse outcomes we studied. Pediatrics 2012;129:e447-e454

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“…7 -10 There is a paucity of data concerning normal pregnancy, although available data indicate that labour itself and the mode of delivery may affect the magnitude and nature of the changes in cytokine levels. 6,10 In one study, complement and some acute phase proteins, measured before, during and after delivery, were stable and had no predictive value in the timing of the onset of labour.…”

Section: Introductionmentioning

confidence: 99%

Maternal Cytokine Balance on the Third Postpartum Day is Not Affected by the Mode of Delivery after Healthy Pregnancies

et al. 2010

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Previous reports have suggested that delivery is associated with the induction of inflammatory cytokines. The present study was designed to investigate whether increased cytokine production was present on postpartum day 3 after a normal pregnancy and whether any changes were associated with the mode of delivery. In total, 33 pregnant women were enrolled; 18 delivered vaginally and 15 underwent an elective caesarean section (C-section). The levels of 17 cytokines and growth hormones were measured at the beginning of delivery or before anaesthesia and on postpartum day 3.While interleukin (IL)-6 and IL-8 levels decreased significantly postpartum, other cytokine concentrations were comparable before and after delivery. Only IL-7 levels were significantly increased in the Csection patients compared with the vaginal birth patients postpartum. In conclusion, there was no risk of a prolonged maternal inflammatory reaction after an uncomplicated vaginal birth or elective C-section, so it is probably not necessary to consider this as an issue when making a decision on the mode of delivery following uncomplicated pregnancy.

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The influence of anaesthetic techniques and type of delivery on peripartum serum interleukin‐6 concentrations

Cited by 55 publications

References 35 publications

Prophylactic Acetaminophen Does Not Prevent Epidural Fever in Nulliparous Women: A Double-Blind Placebo-Controlled Trial

Prophylactic Acetaminophen Does Not Prevent Epidural Fever in Nulliparous Women: A Double-Blind Placebo-Controlled Trial

Intrapartum Temperature Elevation, Epidural Use, and Adverse Outcome in Term Infants

Maternal Cytokine Balance on the Third Postpartum Day is Not Affected by the Mode of Delivery after Healthy Pregnancies

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