Influence of neuraxial labor analgesia on maternal fever and birth outcomes

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Created On: 18/09/2023

A secondary analysis of a multicenter prospective cohort study explored the association between intrapartum fever and neuraxial labor analgesia. Additionally, the impact of maternal fever on perinatal outcomes during the 6 weeks following delivery was also investigated.

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Key take away

Prolonged neuraxial labor analgesia in low-risk pregnancies is linked with a raised risk of intrapartum maternal fever. While intrapartum fever is related to adverse maternal outcomes, neonatal outcomes within the first 6 weeks after delivery remain unaffected.

Background

Method

Females with single- and full-term cephalic pregnancies were incorporated. During labor, intrapartum maternal fever was identified by an axillary temperature of ≥37.5°C. Collection of data on neonatal outcomes, maternal variables, and baseline characteristics was done. For analyzing the link between neuraxial labor analgesia and intrapartum maternal fever, logistic regression models were used.

Employing receiver operating characteristic curve, identification of the cutoff point was done.

Result

Out of 577 parturients, 74 (12.8%) developed intrapartum fever. With or without conforming for confounding factors, neuraxial analgesia was found to be related to a heightened chance of maternal intrapartum fever (adjusted odds ratio [OR] = 2.68). The analysis also revealed that neuraxial analgesia of fewer than 5 hours did not significantly raise the risk of intrapartum fever in comparison with no analgesia (OR = 1.52), while longer neuraxial labor analgesia (over 5 hours) considerably escalated the risk of fever (OR = 3.38).

Furthermore, parturients with intrapartum fever experienced more maternal adverse outcomes in relation to those without fever. Neonates born to females battling intrapartum fever illustrated greater rates of composite adverse neonatal outcomes. However, there was no clinically meaningful difference when compared to neonates born to women without fever.

Conclusion

In young nulliparous women with single and full-term cephalic pregnancies, the utilization of neuraxial analgesia during labor, particularly when administered for more than 5 hours, showed a heightened likelihood of intrapartum fever. Additionally, while intrapartum fever correlated with unfavorable maternal consequences, its impact on the immediate well-being of neonates did not reach statistical significance.