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Does Epidural Analgesia Lead To Maternal Fever?
Abstract Number: GM-03
Abstract Type: Original Research
Background: In recent years, several reports have indicated that maternal temperature elevations during labor may also be observed in the absence of an infection. Presumed noninfectious causes of maternal temperature elevations include epidural analgesia, endogenous heat production generated by the contracting uterus, and delivery in an overheated room. In a recent study, the authors conducted a prospective cohort study in women scheduled for labor induction and determined that the temperature trend in the peripartum period did not change after epidural placement. Because that study focused on afebrile patients, we are now directing our attention to febrile parturients. In this retrospective case-control study, we compare temperature slope change associated with epidural placement between those patients with peripartum fever and afebrile controls.
Methods: We identified all parturients in 2012 who developed fever > 101 deg F at any point or who had a temperature > 100.4 deg F for ≥ 1 hour during admission. We then randomly matched each febrile case with three afebrile controls who also delivered within a 24-hour period of the febrile parturient’s delivery time. We excluded those patients who underwent caesarian section. To evaluate the possible role of epidural analgesia, we compared the temperature slope change before and after epidural analgesia in both the febrile group and afebrile group. We then also determined if there was an association of maternal fever and epidural analgesia and whether there was an association of labor duration and maternal fever.
Results: Women who experienced fever during their labor had a higher epidural rate (97% versus 79%; Pearson χ^2=11.9,p=0.0006) but also had longer labor (15.23 ± 8.78 hours versus 10.09 ± 9.19 hours; log-likelihood χ^2=11.9, p = 0.0002). To determine if epidural analgesia caused fever, we looked at the temporal relationship of temperature and epidural anesthesia in the following manner: we compared the change in slope of temperature - before and after epidural anesthesia - between the two groups. The change in slope was similar in the afebrile group (-0.077 ± 0.423 , mean ± SD) and the febrile group (-0.131 ± 0.389 , mean ± SD). These reductions in the temperature slope did not differ from each other statistically (t-ratio = -0.872, p=0.386).
Conclusions: In this retrospective case-control study, epidural analgesia had no effect on maternal temperature based on the slope analysis in either the febrile or afebrile groups, but a higher epidural placement rate and longer labor times are associated with the febrile group. Since prolonged labor is associated with maternal fever but epidural analgesia does not alter temperature slopes significantly, the epidural placement rate may be higher in the febrile group because their labor is prolonged and therefore more painful, and a longer labor provides additional time to provide epidural analgesia.