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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

The effects of antibiotic prophylaxis on epidural related fever in labor

Abstract Number: T 37
Abstract Type: Original Research

Shiv K Sharma MD, FRCA1 ; Shiv K. Sharma MD2; Beverly B. Rogers MD3; James M. Alexander MD4; Donald D. McIntire Ph.D5; Kenneth J. Leveno MD6

BACKGROUND: Epidural analgesia provides very effective pain relief during labor, its use may be associated with development of maternal fever (> 38° C) in over 20% of women.1 The precise mechanism of the development of maternal fever during epidural analgesia is unclear.5 However, it has been suggested that the development of maternal fever during epidural analgesia could be due to intrapartum infection.11 We investigated whether antibiotic prophylaxis before epidural placement lowers the rate of epidural-related fever.

METHODS: In this double-blind placebo-controlled trial 400 healthy nulliparous women requesting epidural analgesia were randomly assigned to receive either cefoxitin 2 gm or placebo immediately preceding placement of an epidural catheter. Maternal tympanic temperature using a Genius® thermometer (Sherwood Medical, St. Louise, MO) was measured hourly, and intrapartum fever was defined as a maternal temperature of ≥38°C. Neonates born to women with fever were evaluated for possible sepsis, and available placentas were evaluated for the presence of neutrophilic inflammation. The primary outcome was maternal fever during epidural analgesia. This analysis used 80% power to detect a two-tailed significance level of < 0.05.

RESULTS: Thirty eight percent women (75/200) in the cefoxitin group and 40% women (79/200) in the placebo group developed fever (p=0.68). The risk difference (95% confidence interval) for fever ≥ 38°C during labor (antibiotic versus placebo) was - 2.0% ( -11.5 to 7.5), and for fever > 39°C during labor was -1.5% ( - 4.7 to 1.7). Placentas were available from 302 (cefoxitin: n= 150; placebo: n=152) of the study cohort. Approximately half of each study group had placental neutrophilic inflammation, but administration of cefoxitin had no significant effect on any grade of neutrophilic inflammation (cefoxitin: 74/150 (49%) vs Placebo: 84/152 (55%), p=0.30). Fever developed significantly more often in the women with placental neutrophilic inflammation compared to those without such inflammation (73/158 vs. 33/144, p < 0.001; risk difference 23%, [95% CI: 13.0 to 34.0]). There were no significant differences in any neonatal outcomes between the antibiotic and placebo study groups. Sepsis was not diagnosed in any of the infants. There were no neonatal deaths.

DISCUSSION: In this randomized double blind trial in low risk women at term fever during labor epidural analgesia was associated with placental inflammation. However, fever and placental inflammation was not reduced with antibiotic prophylaxis. This finding suggests that infection is unlikely to be the cause in its development.

REFERENCES

1. Anesthesiology 2004;100:142–8.

2. Anesth Analg 2010;111:1467–75.

3. Birth 2000; 27:206-8.

SOAP 2013