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Re: fever after epidural From: art fougner, md (evsono@pipeline.com) Wed Jan 10 09:21:49 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: art fougner, md: "Re: Practice philosophies, was JW and Blood refusal LONG" Previous message: art fougner, md: "Re: Hypophosphatasia and pregnancy" In reply to: Griffiths Malcolm: "Re: fever after epidural" 3 relatively recent reviews - 1: Am J Perinatol 2000;17(3):127-30 Association between epidural analgesia and intrapartum fever. Gonen R, Korobochka R, Degani S, Gaitini L Department of Obstetrics & Gynecology, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel. [Medline record in process] The objective of this paper is to determine whether or not epidural analgesia is an independent risk factor for intrapartum fever. Maternal temperature was measured every 4 h during labor to 1004 consecutive women in term labor. Women with fever or on antibiotics were excluded. Epidural analgesia was administered upon patients' request. Of the 406 (40%) women who received epidural analgesia, 11.8% (n = 48) developed a fever > or = 37.8 degrees C during labor compared with only 0.2% (n = 1) of women not receiving epidural analgesia. Women who received epidural analgesia were more likely to have one or more risk factors for intrapartum infection. Their labor and ruptured membranes were longer, they were more likely to have internal monitoring and have more vaginal examinations. Compared with women who received epidural analgesia and did not develop intrapartum fever, women that did develop fever had longer epidurals and more risk factors for infection. However, in a logistic regression analysis with fever as dependent variable, only the duration of epidural was significantly associated with the occurrence of fever. The rate of fever increased with longer labors, from 5% with labor < 3 h to 28% with labor > 6 h. In 90% of women the fever resolved within a few hours after delivery. Sepsis evaluation was negative in all of the newborns to mother who had intrapartum fever. Our data support a noninfectious etiology for intrapartum fever in the vast majority of our patients. However, infection must be ruled out before a decision is made to withhold antibiotic therapy. PMID: 11012136, UI: 20464731 2: Reg Anesth Pain Med 2000 Sep-Oct;25(5):549-53 Maternal fever, neonatal sepsis evaluation, and epidural labor analgesia. Viscomi CM, Manullang T Department of Anesthesiology, University of Utah, Salt Lake City 84132, USA. cviscomi@anesth.med.utah.edu [Medline record in process] BACKGROUND AND OBJECTIVES: Numerous studies have found an association between epidural analgesia for labor and maternal fever (temperature > or 8 degrees C). Maternal fever often results in treatment with maternal or neonatal antibiotics, neonatal sepsis evaluation, and increased costs. METHODS: Medline was used to identify literature regarding the association between epidural labor analgesia and maternal fever/neonatal sepsis. Studies examining thermoregulation during pregnancy and/or epidural analgesia were also reviewed. RESULTS: There appears to be a strong association between epidural labor analgesia and maternal fever. The link between epidural labor analgesia and neonatal sepsis evaluation is less clear. The incidence of confirmed neonatal sepsis does not increase with maternal epidural analgesia. Causes of the association between epidural labor analgesia and maternal fever include selection bias, altered thermoregulation, and increased shivering or decreased sweating with epidural analgesia. CONCLUSIONS: Maternal epidural labor analgesia is associated with maternal fever and possibly increased neonatal sepsis evaluation. There is no proof the relationship is causal. PMID: 11009245, UI: 20462769 3: Anesthesiology 1999 May;90(5):1271-5 Epidural analgesia during labor and maternal fever. Philip J, Alexander JM, Sharma SK, Leveno KJ, McIntire DD, Wiley J Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas 75235-9068, USA. jphili@mednet.swmed.edu BACKGROUND: In recent observational studies, epidural analgesia during labor at patient request has been associated with maternal fever. The authors report a secondary analysis of fever in women who were randomized to receive either epidural or patient-controlled intravenous analgesia during labor. METHODS: Maternal tympanic temperature was measured during spontaneous labor in 715 women at term who were randomized to either epidural analgesia with bupivacaine and fentanyl or to patient-controlled intravenous analgesia with meperidine. Intent-to-treat analysis of women with fever (temperature > or = 38.0 degrees C) versus those without was performed using Student t test and Fisher exact test to determine statistical significance (P < 0.05). RESULTS: Epidural analgesia was associated with maternal fever (odds ratio = 4.0; 95% confidence interval 2.0-7.7), as was nulliparity (odds ratio = 4.1; 95% confidence interval = 1.8-9.1) and labor longer than 12 h (odds ratio = 5.4; 95% confidence interval 2.9-9.9). These factors were all independent variables for maternal fever when analyzed using logistic regression. CONCLUSIONS: Epidural analgesia is associated with maternal fever. However, nulliparity and dysfunctional labor are also significant cofactors in the fever attributed to epidural analgesia. Publication Types: Clinical trial Randomized controlled trial Comments: Comment in: Anesthesiology 1999 May;90(5):1250-2 hope this helps. art At Wed, 10 Jan 2001, Griffiths Malcolm wrote: > >This was reported also in the Lancet I think late 1980's authors were Luca >Fusi and Prof Phil Steer, then at West London Hospital. > >-----Original Message----- >From: Braun, R. Daniel [mailto:rbraun@iupui.edu] >Sent: 10 January 2001 02:43 >To: Multiple recipients of list OB-GYN-L >Subject: Re: fever after epidural > > There is some evidence that epidural by itself induces a fever in a >significant number of patients. I don't remember whereit was published, but >it was written by Watson Bowes. > >Dan > >-----Original Message----- >From: Ricardo SavarisTo: Multiple recipients of list OB-GYN-L >Sent: 1/9/01 7:37 PM >Subject: Re: fever after epidural > >Maggie > >My personal idea is to avoid antibiotic before urine sample and >hemograme. I >have seen a case of fluid contamination (i.e. 5DW), but I don't believe >that >your country would have this kind of problem. I agree with you that it >is >too early for chorio > >I would wait a little bit long, check CBC and Urine and follow the >evolution >of the case. > >Ricardo Savaris, MD >Brazil > >>----- Original Message ----- >From: maggie cnm <maggiela@rochester.rr.com> >To: Multiple recipients of list OB-GYN-L <ob-gyn-l@forum.obgyn.net> >Sent: Saturday, December 30, 2000 4:20 PM >Subject: fever after epidural > >> Opinions, please. >> G3P2 in for AROM and pit augmentation at term. (Too many details as >to >> why, etc and not really important to question.) AROM clear fluid at 3 >> cms. Labs normal, WBC 18.2.(We use 20 as significant) Labor >progressed >> well with minimal pitocin. Pt requested and received an epidural at 4 >> cms (around 5pm). VS all normal,temp 37.4,pulse~100 (had been that >way >> at admission). At 6pm, pt's temp was 38.6. Started her on Clinda >(PCN >> allergy) with plans to add Gent but she delivered as the first Clinda >> ran in. Temp at delivery 39. Plan was to continue the atbx for >> overnight and see if she became afebrile. Baby was fine...off to >> special care because of maternal temp. Nothing suspicious about the >> placenta or amniotic fluid, etc. >> Is it possible that this was some type of response to the bupivicaine >or >> fentanyl in the epidural? Anesthesia said that it was not, but since >she >> was fine prior to the epidural, I wonder. Certainly this could have >> been chorio but she was AROMed only 2 hours prior to giving birth. >> I have read a few studies that show a correlation between maternal >temps >> and epidural use but it seems that the temp elevates only after a few >> hours with the epidural in place. >> Thanks for your opinions.... >> >> -- >> Maggie, CNM >> -- art fougner, md A series of 1000 cases begins with but a single anecdote. Next message: art fougner, md: "Re: Practice philosophies, was JW and Blood refusal LONG" Previous message: art fougner, md: "Re: Hypophosphatasia and pregnancy" In reply to: Griffiths Malcolm: "Re: fever after epidural"

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