Perinatal outcomes and risk factors for epidural analgesia-associated intrapartum maternal fever: a retrospective study
Hui Wang, Zaiping Yang, Siyi Wei, Lina Xia, Yan Li, Xiao‐Feng Wu, Xian-Hua Lin, Feng Lu
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: = 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.