///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

ELEVATED MATERNAL BODY TEMPERATURE IN WOMEN LABORING WITH EPIDURAL ANALGESIA AND NEONATAL SYSTEMIC INFLAMMATORY RESPONSE: IS THERE AN ASSOCIATION?

Abstract Number: 96
Abstract Type: Original Research

Hanna Billert MD, PhD1 ; Leon Drobnik MD,PhD2; Michał Gaca MD,PhD3; Grzegorz H Bręborowicz MD,PhD4; Krzysztof M Kuczkowski MD,PhD5

Introduction: Most studies indicate that epidural analgesia (EA) during labor is associated with maternal hyperthermia, although the nature of this "fever" is not clear (1). The purpose of this prospective observational study was to determine possible association between elevated maternal body temperature in women laboring with EA and neonatal systemic inflammatory response.

Methods: Twenty seven healthy, term [19 nulliparous (NEA) and 8 multiparous (MEA)] women in spontaneous labor received (on request) an EA by intermittent boluses of 0.125% bupivacaine + fentanyl, 5 μg mL-1. Control group included 24 similar healthy term [14 nulliparous (NMep) and 10 multiparous (MMep)] women who received systemic meperidine (Mep) for labor pain. Maternal tympanic temperature was measured immediately after delivery. Umbilical cord blood gas sampling, measurement of the"inflammatory indices" [interleukin-6, (IL-6), C-reactive protein (CRP), leukocyte count (L), and luminol-dependent chemiluminescence (CL)], and levels of "stress hormones" [cortisol (CORT), β-endorphin (β-ENDO), epinephrine and norepinephrine (NE)] were performed at delivery. Mann-Whitney U-Test was used for data analysis.

Results: No maternal and neonatal demographic differences were noted among the groups. The tympanic temperature at birth was increased in the EA patients and higher in NEA group (median 37.0 vs. 36.5, p=0.010). All neonates were born with Apgar scores > 8. Neonates in the NEA group had higher umbilical cord arterial blood pH values than the NMep (7.34 vs. 7.25; p=0.006) group neonates. Neonates born to mothers in EA groups had elevated CRP levels. NEA group neonates had higher NE and lower CL and β-E than the Mep group neonates. Neonates born to mothers in MEA group had lower L and higher β-E concentrations when compared to controls (Table 1). In the NEA group maternal temperature correlated with cord blood NE and IL-6 levels (Spearmans rho 0.50 (p=0.03) and 0.53 (p=0.03).

Discussion: The consequences of maternal fever may include increased neonatal evaluations for sepsis and the increased use of antibiotics. EA is used for control of labor pain worldwide, yet there is no consensus about what unintended effects it may cause.

Conclusions: We conclude that elevated maternal body temperature in nulliparous women laboring with EA may lead to neonatal systemic inflammatory response. Validation of this association requires further studies.

Reference:

1. AJOG 2002; 187:834-8.



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