Interventions for the prevention or treatment of epidural-related maternal fever: a systematic review and meta-analysis

Cartledge, Anna; Hind, Daniel; Bradburn, Mike; James, Marrissa Martyn-St; Davenport, Sophie; Tung, Wei Shao; Yung, Hwu; Wong, Jeyinn; Wilson, Matthew

doi:10.1016/j.bja.2022.06.022

Cited by 6 publications

(3 citation statements)

References 84 publications

(324 reference statements)

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“…The association between the use of EA and intrapartum fever has not yet been completely understood. 4 Sterile inflammation and activation of inflammatory response most probably play a crucial role, 48 , 49 without compromising fetal wellness. Our data confirmed a higher incidence of intrapartum fever in women undergoing EA with similar rates in meconium-stained amniotic fluid and NICU admissions.…”

Section: Discussionmentioning

confidence: 99%

The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

Ambrosetti¹,

Grandi²,

PETRELLA³

et al. 2023

AJOG Global Reports

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Section: Discussionmentioning

confidence: 99%

The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

Ambrosetti¹,

Grandi²,

PETRELLA³

et al. 2023

AJOG Global Reports

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“…A lower risk of epidural related maternal fever has been reported with intermittent compared with continuous epidural dosing regimens [37]. Currently, there are no therapeutic or preventive strategies to address this phenomenon, nor any way of differentiating epidural related maternal fever from other causes of hyperthermia, meaning that all women with fever in labour should be assessed, investigated and treated for potential infection in keeping with guidelines [38]. This results in a large number of women and neonates being exposed to antibiotics unnecessarily, an intervention associated with short-term risks of allergy as well as longer-term implications of developing antibiotic resistance.…”

Section: Long-term Effects In the Neonatementioning

confidence: 99%

Long-term effects of neuraxial analgesia

Kearns,

Broom,

Lucas

2024

Current Opinion in Anaesthesiology

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Purpose of review This review article explores the potential longer-term implications of neuraxial analgesia in labour for both the mother and her child. Recent findings Neuraxial techniques for labour analgesia are well tolerated and effective, and long-term adverse sequelae are rare. Labour epidural analgesia is not independently associated with long-term headache, backache, postnatal depression or anal sphincter injury, and evidence supports that epidurals may offer protection against severe maternal morbidity, particularly in women at a higher risk of complications. However, there is an increasing awareness that postdural puncture headache may be associated with chronic headache, back pain and postnatal depression, emphasizing the need for adequate follow-up until symptoms resolve. For the neonate, a growing body of evidence refutes any association between epidural analgesia in labour and the later development of autism spectrum disorder. The clinical significance of epidural related maternal fever remains uncertain and is a research priority. Summary Women should continue to access the significant benefits of neuraxial analgesia in labour without undue concern about adverse sequelae for themselves or their offspring. Measures to prevent, appropriately manage and adequately follow-up women who have suffered complications of neuraxial analgesia, such as postdural puncture headache, are good practice and can mitigate the development of long-term sequelae.

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“…Previous studies (Arendt & Segal, 2013; Segal, 2010; Sharpe & Arendt, 2017) show that intrapartum fever rates of women in labour who receive epidural labour analgesia are significantly higher than for those who do not receive this. The incidence of intrapartum fever varies greatly (1.6%–46.3%) in various studies, with an average incidence of about 20% (Cartledge et al, 2022; Jiang et al, 2021; Ren et al, 2021). This is significant as it can interfere with the clinical management of women in labour during the delivery process, leading to an increase in the proportion of caesarean section and instrument assisted deliveries.…”

Section: Introductionmentioning

confidence: 99%

Maternal intrapartum fever during epidural labour analgesia: Incidence and influencing factors

Yuan,

Jin,

Shen

et al. 2023

Int J of Nursing Practice

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BackgroundThe management and nursing care of women's temperature during delivery is an important part of clinical obstetrics. We aimed to evaluate maternal intrapartum fever during epidural labour analgesia to provide evidence for the management and care of women in labour.MethodsThis study was conducted and reported according to the STROBE statement. Women in labour undergoing epidural labour analgesia in our hospital from 1 January 2021 to 31 August 2022 were retrospectively selected. The characteristics of women in labour with and without intrapartum fever were compared. Pearson correlation and logistic regression analysis were used to analyse the influencing factors of postpartum fever.ResultsA total of 196 women in labour were included, the incidence of maternal intrapartum fever in women in labour undergoing epidural analgesia was 27.5%. Pearson correlation analyses showed that BMI, oxytocin use, labour duration, number of vaginal examinations, time from rupture of the foetal membranes to the end of labour and duration of epidural analgesia were all correlated with the occurrence of intrapartum fever (all P < 0.05). Logistic regression analyses indicated that body mass index ≥28 kg/m2(OR = 1.825), oxytocin use (OR = 2.082), labour duration ≥9.2 h (OR = 2.613), number of vaginal examinations ≥8 (OR = 2.044–3.115), the time from rupture of the foetal membranes to the end of labour ≥250 min (OR = 2.766) and duration of epidural analgesia ≥300 min (OR = 3.106) were risk factors for intrapartum fever in women in labour undergoing epidural analgesia (all P < 0.05).ConclusionsMaternal intrapartum fever in women in labour undergoing epidural analgesia is common and influenced by many factors. Nurses should take early preventive care measures according to these factors during epidural analgesia in labour.

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Interventions for the prevention or treatment of epidural-related maternal fever: a systematic review and meta-analysis

Cited by 6 publications

References 84 publications

The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

Long-term effects of neuraxial analgesia

Maternal intrapartum fever during epidural labour analgesia: Incidence and influencing factors

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