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Intrapartum Fever and Epidural Insertion: A UK National Survey
Abstract Number: S-72
Abstract Type: Original Research
Introduction: As sepsis remains a leading cause of maternal mortality (1), temperature monitoring during the intrapartum period is essential (2). Clinicians must be vigilant in recognizing and managing intrapartum fever (IPF) to optimize neonatal and maternal management.
Methods: Following approval from The Obstetric Anaesthetist's Association Audit subcommittee (Survey 150), all UK members were invited to complete an electronic survey. Questions examined knowledge about monitoring intrapartum temperature and explored whether the presence of maternal fever affected their anesthetic management. Chi-square test was used to compare categorical data; p<0.05 was regarded statistically significant.
Results: From the 1668 UK members, 571 responded (34% response rate), and 74% were attending grade. Only 29% and 13% correctly knew the UK nationally recommended frequency of temperature monitoring during the 1st and 2nd stages of labor respectively. Only 12% knew the definition of IPF as per NICE guidelines (2 readings >37.5ºC 1 hour apart, or 1 reading >38ºC). Management involving blood cultures, acetaminophen and antibiotics would be initiated by 36% once IPF is diagnosed. Senior anesthesiologists are more inclined to monitor temperature after epidural insertion compared with residents (8% vs 0.7%, p=0.01). Figure 1 shows how the presence of IPF would influence labor epidural management amongst our respondents. 22% felt epidural insertion in the presence of IPF warrants an individualised patient plan, comprising of multidisciplinary team (MDT) discussion, clinical assessment, investigation and treatment for sepsis including acetaminophen.
Discussion: Despite ongoing efforts to increase awareness of maternal sepsis, high proportions of UK obstetric anesthesiologists have inadequate knowledge about monitoring intrapartum temperature and IPF. MDT education and local audit should be encouraged to improve knowledge and management of IPF. Divided opinions on epidural insertion in the presence of IPF reflect the lack of UK consensus on this subject. Until national guidelines are available, local departments should provide anesthesiologists with clear recommendations on epidural insertion in the presence of maternal fever.
1. MBRRACE-UK: Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK, 2014
2. National Institute of Health and Care Excellence (2014) [Intrapartum Care: Care of Healthy Women and their Babies during Childbirth]. [CG190]. London. National Institute of Health and Care Excellence.