Epidural Labor Analgesia and Neonatal Sepsis Evaluation Rate: A Quality Improvement Study

Kaul, Bupesh; Vallejo, Manuel C.; Ramanathan, Sivam; Mandell, Gordon L.

doi:10.1097/00000539-200110000-00038

Cited by 50 publications

(34 citation statements)

References 4 publications

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“…Guidelines for neonatal sepsis evaluation at our institution include prolonged rupture of membranes (>18 h) and chorioamnionitis; neonatal conditions include hypo-or hyperthermia at 6 h after birth, apneic spells, respiratory distress or pneumonia, central cyanosis, listlessness, convulsions, poor feeding or vomiting, and cardiovascular instability. 3 The frequency and time of epidural boluses, and the type and amount of epidural medication used were documented. Obstetric variables were number of vaginal examinations, use of oxytocin augmentation or internal monitors, time at which the membranes ruptured, whether spontaneously or artificially, group B Streptococcus colonization, and clinical suspicion of chorioamnionitis.…”

Section: Methodsmentioning

confidence: 99%

“…2 However, a study performed at our own institution found no such association between epidural analgesia and NSE. 3 Similarly, Philip et al found that in the absence of maternal fever, epidural analgesia did not increase the NSE rate. 4 Most studies investigating maternal fever with epidural analgesia have been performed on parturients receiving continuous infusions.…”

Section: Introductionmentioning

confidence: 94%

See 1 more Smart Citation

The incidence of maternal fever during labor is less with intermittent than with continuous epidural analgesia: a randomized controlled trial

Mantha

Vallejo

Ramesh

et al. 2008

International Journal of Obstetric Anesthesia

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

The incidence of maternal fever during labor is less with intermittent than with continuous epidural analgesia: a randomized controlled trial

Mantha

Vallejo

Ramesh

et al. 2008

International Journal of Obstetric Anesthesia

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“…[83][84][85][86] Although it is clear that maternal temperature increases in some women who receive labor epidural analgesia, the cause of the increase is controversial. 84 The mechanisms of the association between labor analgesia and maternal fever have not been fully elucidated.…”

Section: Fever: Epidural Analgesia and Maternal "Fever"mentioning

confidence: 99%

The febrile parturient: choice of anesthesia

Kuczkowski

2002

Southern African Journal of Anaesthesia and Analgesia

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The febrile parturient: choice of anesthesia ture and temperature control mechanisms that constantly adjust body temperature, to maintain this level. Fever is defined as an increase in core body temperature above 38 ºC, which is secondary to an increase in the hypothalamic set point. 1, 3 The human body temperature rarely exceeds 41ºC. Normal circadian fluctuation in body temperature with increase in the evening and decrease in the morning continues even in febrile patients. 4 Under normal circumstances, core body temperature is tightly regulated, with a variation of approximately 0.5ºC. While it is uncertain as to the benefits of fever, there are suggestions that the increased body temperature aids in the activation of the host immune response with augmentation of bactericidal, phagocytic and chemotactic properties of polymorphonuclear leukocytes. The negative aspects of fever include increased basal metabolic rate and increased cardiac demand. FEVER: INTERACTION WITH PREGNANCYPhysiologic changes of pregnancy include an increase in the maternal basal metabolic rate. 5 Maternal body temperature in labor is also significantly affected by the degree of physical activity and intensity of uterine contractions. Pain associ- INTRODUCTION Fever is a common clinical problem in labor and delivery suites -worldwide. The febrile parturient presents a unique diagnostic dilemma and therapeutic challenge to both an obstetrician and an anesthesiologist involved in her care. Fever can result from a variety of infectious microorganisms, tissue trauma, malignancy, drug administration, endocrine and immunological disorders. However, infection is by far the most common cause of fever in the parturient. 1, 2 The infectious etiology of fever in a parturient may be pregnancy specific, such as chorioamnionitis, or not specific to pregnancy, such as urinary tract infection. The risk to the mother and the fetus is significantly increased in pregnancy complicated by infection and fever. The diverse clinical manifestations of various infectious disorders combined with the unique anesthetic implications of pregnancy may result in life-threatening complications and significantly impact upon the practice of obstetric anesthesia.The diagnosis of infection in pregnancy often raises questions about the safety of neuraxial anesthesia in febrile patients. Despite this concern, and lack of universal guidelines, it has now been well established that the presence of infection and fever in labor does not always contraindicate the administration of regional anesthesia. 2 The decision whether to administer regional anesthesia or not in a febrile parturient should be based on an individual risk-to-benefit ratio.

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“…Similarly, Greenwell et al 26 concluded that "Among low-risk women receiving epidural analgesia, intrapartum maternal temperature >99.51F was associated with adverse neonatal outcomes," without highlighting that prolonged labor was a highly significant (P < 0.0001) predictor that offered a much more plausible explanation of the observed association. As Segal 27 noted in a recent review article, studies that make mention of maternal temperature while investigating effects of labor analgesia can be categorized as observational [28][29][30][31][32] and randomized controlled trials. [33][34][35][36][37] The common thread among those studies is that although there is a higher proportion of mothers who have Z1 temperature reading >100.41F in the epidural group, patients receiving epidural analgesia also tend to have longer labor, one of the known risk factors for chorioamnionitis.…”

Section: Epidural Analgesia and Fevermentioning

confidence: 99%

Labor Epidural Fever and Chorioamnionitis

Frölich

2014

International Anesthesiology Clinics

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Epidural analgesia has emerged as the gold standard of pain relief for women in labor. It provides the most effective form of analgesia, with minimal transfer of drugs to the fetus. This method has withstood a very exhaustive exploration of intended and unintended effects over time, 1 but episodically cautionary and, at times, profoundly critical remarks have resurfaced. Some obstetricians felt that epidural analgesia might cause detrimental changes in labor patterns, whereas some suggested an adverse effect on the cesarean section rate, a possible increased incidence of postpartum back pain and interference with breastfeeding. Many problems are attributed to the technique without appropriate scientific assessment. 2 The most recent cause of concern to pregnant women, however, is the notion that epidural analgesia could cause fever 3 and, as a consequence, neonatal encephalopathy. 4,5 In this review, background on the topic of maternal fever and a discussion of the artifactual association of fever and the use of epidural analgesia for labor will be discussed. ' Fever Fever can be described as an elevation of the central thermoregulatory set point, largely achieved by disinhibiting thermogenesis. This definition is the result of over 100 years of research, during which the molecules mediating the fever response have been identified. Some were discovered only recently by groups investigating not exclusively fever but temperature homeostasis in general. Fever alone rarely revealed the nature of a pathology conclusively. The investigation into the mechanism causing fever led to the description of pyrogens, substances that can induce fever. One of the best studied exogenous

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Epidural Labor Analgesia and Neonatal Sepsis Evaluation Rate: A Quality Improvement Study

Cited by 50 publications

References 4 publications

The incidence of maternal fever during labor is less with intermittent than with continuous epidural analgesia: a randomized controlled trial

The incidence of maternal fever during labor is less with intermittent than with continuous epidural analgesia: a randomized controlled trial

The febrile parturient: choice of anesthesia

Labor Epidural Fever and Chorioamnionitis

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