///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

Labor Epidural Fever and Pyrogenic Cytokines

Abstract Number: 110
Abstract Type: Original Research

Stephen Patteson Associate Professor1 ; Cara Erickson M.D.2; Snider Carolyn MT3; Roger Carroll PhD4

Introduction: An association between epidural analgesia in laboring women and maternal fever has been identified. The mechanism of epidural fevers, reportedly 14% to 33%, is unknown. One theory is a noninfectious inflammatory cause. A variety of human cytokines have been identified with inflammation as well as fever. This study investigates specific cytokine levels in laboring women prior to and after placement of labor epidurals. The null hypothesis is that labor epidurals do not elevate inflammatory cytokine levels which could cause fever. Methods: After IRB approval and patient consent, 5 ml of blood was drawn prior to epidural placement and then every four hours until delivery. Blood was drawn from a sterile percutaneous site. Maternal temperature was assessed during labor. Quantitative interleukin -1β (IL-1β), interleukin-6 (IL-6), interleukin-8(IL-8), tumor necrosis factor - α (TNF-α), and granulocyte-macrophage colony-stimulating factor (GM-CSF) levels were measured using the Millipex MAG human cytokine panel (Millipore; Billerica, MA). Results: Six patients were consented and had blood samples collected. The mean age was 25.0 years 7.8, mean gestational age was 38.9 weeks 1.0, pre-epidural white blood cell count (WBC) was 10,700 3.1, post delivery WBC was 14,800 4.2. The assay kit failed to measure data in one patient. Of the remaining five patients, one delivered prior to the second blood draw. All six patients had increased temperature from baseline after delivery. The range of temperature (T) increase was between 0.9-2.2 degrees F. None of the six patients developed a fever >100.4. T max for any patient was 100.0 degrees F. One patient had all five elevated cytokines at baseline as compared with the four other patients with data. Prior to the second draw she received PCN for unknown Group Beta Streptococcus status after placement of the epidural. She had also received 2 doses of Tylenol 650 mg, one day prior to and the morning of epidural placement. There was no statistical significance between baseline and cytokine levels 4 hours after epidural placement. There appeared to be a positive correlation between GM-CSF and maximum temperature after delivery. Discussion: This is the presentation of the initial patients consented in this study. Although patients served as their own control prior to receiving labor epidural, a control group of patients without epidural placement is planned. As the study progresses we expect to have patients with fever > 100.4F. One patient presented with elevated cytokines prior to epidural placement but was empirically treated with antibiotics and antipyretics. Summary: Human cytokine levels as measured by IL-1β, IL-6, IL-8, TNF-α, and GM-CSF do not appear to be elevated by labor epidural placement. No patient developed a fever >100.4 F. There may be a positive correlation between GM-CSF and maximum maternal temperature after delivery.

SOAP 2010