Perinatal outcomes and risk factors for epidural analgesia-associated intrapartum maternal fever: a retrospective study

Abstract

Background

Epidural analgesia (EA) increases the risks of maternal fever during labor, which is associated with adverse maternal and neonatal outcomes, while the risk factors for epidural-associated fever and strategies for minimizing these effects remain limited.

Methods

A total of 325 pregnant women were retrospectively analyzed who had attended our hospital for a vaginal in-hospital delivery, including 208 who voluntarily accepted EA and 117 who did not receive EA. During labor, 208 EA women were allocated to a fever group (n = 42, a tympanic temperature ≥37.5 °C during labor), and a no fever group (n = 166). The outcome measures included main maternal and neonatal outcomes, labor times, duration of EA and the total EA dosage administered.

Results

42 out of 208 women given EA exhibited fever temperatures during labor, which were higher than in women who did not receive EA (20.19% vs. 0.85%). Maternal fever had an increased risks for conversion to surgery (adjusted odds ratio (AOR), 4.05; 95% CI, 1.44–11.39) and neonatal infections (5.13; 1.98–13.29) compared to the no fever group. While maternal fever did not increase the risks for assisted vaginal delivery, fetal distress or admission to the neonatal intensive care unit (NICU), it was predominantly associated with primiparity and lesser times of gravity. Frequent cervical examinations, the duration of first stage and total labor, and the duration of EA and its total dosage were positively correlated with the incidence of fever. Furthermore, after stratifying risk factors into subgroups, we found that more frequent cervical examinations (≥7 times) and longer duration of first stage (≥442.5 min), total labor time (≥490 min), EA (≥610.0 min) increased the risk for epidural-associated fever after adjustment for potential confounding factors.

Conclusions

EA increased the risk of intrapartum epidural-associated fever, which was correlated with adverse perinatal outcomes. Nulliparity, less times of gravidity, ≥7 cervical examinations, increased volume of the EA dosage, prolonged duration of EA and total labor time were risk factors for epidural-associated fever. The findings provide clinicians with insights and strategies to prevent epidural-associated fever more safely and effectively.

Keywords:

• Epidural analgesia
• intrapartum maternal fever
• labor time
• perinatal outcome

Acknowledgements

We thank our patients and the information technologist for the data collecting.

Authors’ contributions

FL and X-HL conceived the study and contributed to the design of the study. HW, L-NX, YL and X-FW contributed to data collection. HW and Z-PY contributed to the analyze and paper writing. S-YW contributed to paper modification. All authors contributed to the article and approved the submitted version.

Ethical approval

All methods were carried out in accordance with relevant guidelines and regulations. This research study was conducted retrospectively from data obtained for clinical purposes. Ethics approval was obtained from the research ethics committee at Child Health Hospital of Songjiang District.

Consent form

Written informed consent was provided by participants before study participation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and analyzed during the current study available from the corresponding author on reasonable request.

Additional information

Funding

This study was funded by the National Key Research and Development Program of China [2018YFC1005001 to X.-H.L.], the National Natural Science Foundation of China [82071730 to X.-H.L.]. Shen Kang Clinical Science and Technology Innovation Project [SHDC12019X17 to X.-H.L.]. Science and Technology Commission of Songjiang District [20SJKJGG171 to F.L].