The impact of intrapartum fever severity associated with epidural labor analgesia on maternal and neonatal perinatal outcomes

doi:10.11958/20250020

Abstract

Abstract:

Objective To investigate the impact of different degrees of fever during epidural labor analgesia on maternal and neonatal perinatal outcomes. Methods A retrospective analysis was conducted on 240 pregnant women who received epidural labor analgesia. Based on the peak temperature during labor, the participants were divided into the control group (<37.3 ℃, 160 cases), the A group (37.3 to <38 ℃, 55 cases) and the B group (≥38 ℃, 25 cases). The differences in maternal prenatal data, labor progression and neonatal outcomes were compared between the three groups. Results There were no significant differences in mode of delivery, onset of labor and membrane rupture method between the three groups (P > 0.05). The time interval from the initiation of epidural analgesia to delivery and the time from membrane rupture to delivery were longer in the A group and the B group compared to the control group (P < 0.05). Among women who delivered vaginally, the first stage of labor was longer in the A group and the B group compared to the control group (P < 0.05), and the second stage and total duration of labor were longer in the A group than those in both the control group and the B group (P < 0.05). There were no significant differences in neonatal Apgar scores, birth weight, umbilical blood pH and the incidence of neonatal complications between the three groups (P > 0.05). Conclusion Longer epidural analgesia duration and a prolonged first stage of labor may increase the risk of labor-associated fever. Higher degree of fever during labor promotes more active intervention in the second stage of labor, but it does not significantly affect neonatal outcomes.

Key words: analgesia, epidural, parturition, epidural-related maternal fever, perinatal outcomes

CLC Number:

R714.3

Figures/Tables 4

References 21

[1]	ZHA Y, GONG X, YANG C, et al. Epidural analgesia during labor and its optimal initiation time-points:a real-world study on 400 Chinese nulliparas[J]. Medicine(Baltimore), 2021, 100(9):e24923. doi:10.1097/MD.0000000000024923.
[2]	SMITH A, LAFLAMME E, KOMANECKY C. Pain management in labor[J]. Am Fam Physician, 2021, 103(6):355-364.
[3]	GOETZL L. Maternal fever in labor:etiologies,consequences,and clinical management[J]. Am J Obstet Gynecol, 2023, 228(5S):S1274-S1282. doi:10.1016/j.ajog.2022.11.002.
[4]	LU G, YAO W, CHEN X, et al. Remifentanil patient-controlled versus epidural analgesia on intrapartum maternal fever:a systematic review and meta-analysis[J]. BMC Pregnancy Childbirth, 2020, 20(1):151. doi:10.1186/s12884-020-2800-y.
[5]	YUAN J, JIN A, SHEN J, et al. Maternal intrapartum fever during epidural labour analgesia:incidence and influencing factors[J]. Int J Nurs Pract, 2024, 30(1):e13188. doi:10.1111/ijn.13188.
[6]	PATEL S, CIECHANOWICZ S, BLUMENFELD Y J, et al. Epidural-related maternal fever:incidence,pathophysiology,outcomes,and management[J]. Am J Obstet Gynecol, 2023, 228(5S):S1283-S1304.e1. doi:10.1016/j.ajog.2022.06.026.
[7]	CHANG X Y, WANG L Z, XIA F, et al. Factors associated with epidural-related maternal fever in low-risk term women:a systematic review[J]. Int J Obstet Anesth, 2023, 56:103915. doi:10.1016/j.ijoa.2023.103915.
[8]	HENSEL D, ZHANG F, CARTER E B, et al. Severity of intrapartum fever and neonatal outcomes[J]. Am J Obstet Gynecol, 2022, 227(3):513.e1-513.e8. doi:10.1016/j.ajog.2022.05.031.
[9]	任洁. 硬膜外分娩镇痛期间产妇产间发热影响因素的Logistic回归分析[D]. 郑州: 郑州大学, 2021:18.
	REN J. Logistic regression analysis of the factors influencing intra-partum fever during epidural labor analgesia[D]. Zhengzhou: Zhengzhou University, 2021:18. doi:10.27466/d.cnki.gzzdu.2021.001926.
[10]	MORTON S, KUA J, MULLINGTON C J. Epidural analgesia,intrapartum hyperthermia,and neonatal brain injury:a systematic review and meta-analysis[J]. Br J Anaesth, 2021, 126(2):500-515. doi:10.1016/j.bja.2020.09.046.
[11]	AN H, ZHENG W, ZHU Q, et al. A retrospective study of risk factors for early-onset neonatal sepsis with intrapartum maternal fever[J]. PeerJ, 2022, 10:e13834. doi:10.7717/peerj.13834.
[12]	曾梅, 程曦, 刘小玲, 等. 分娩镇痛产时发热对母婴结局影响的国内外研究进展[J]. 医学理论与实践, 2024, 37(5):757-759.
	ZENG M, CHENG X, LIU X L, et al. Advances in domestic and international research on the impact of labor analgesia-related intra-partum fever on maternal and neonatal outcomes[J]. Medical Theory and Practice, 2024, 37(5):757-759. doi:10.19381/j.issn.1001-7585.2024.05.011.
[13]	张雪寅, 陈立建. 程控硬膜外间歇脉冲注入与连续硬膜外输注对产妇分娩期内发热的影响[J]. 天津医药, 2021, 49(7):752-756.
	ZHANG X Y, CHEN L J. The influence of programmed intermittent epidural bolus and continuous epidural infusion on fever during delivery[J]. Tianjin Med J, 2021, 49(7):752-756. doi:10.11958/20202487.
[14]	JUNG E, ROMERO R, SUKSAI M, et al. Clinical chorioamnionitis at term:definition,pathogenesis,microbiology,diagnosis,and treatment[J]. Am J Obstet Gynecol, 2024, 230(3S):S807-S840. doi:10.1016/j.ajog.2023.02.002.
[15]	LI L, YANG Z, ZHANG W. Epidural dexmedetomidine for prevention of intrapartum fever during labor analgesia:a randomized controlled trial[J]. Pain Ther, 2021, 10(1):391-400. doi:10.1007/s40122-020-00215-y.
[16]	WOHLRAB P, BOEHME S, KAUN C, et al. Ropivacaine activates multiple proapoptotic and inflammatory signaling pathways that might subsume to trigger epidural-related maternal fever[J]. Anesth Analg, 2020, 130(2):321-331. doi:10.1213/ANE.0000000000004402.
[17]	曹家刚, 李胜华, 冯迪, 等. 不同浓度罗哌卡因复合舒芬太尼分娩镇痛对产妇产间发热的影响[J]. 临床麻醉学杂志, 2019, 35(4):327-330.
	CAO J G, LI S H, FENG D, et al. Effects of different concentrations of ropivacaine for labor analgesia on maternal inpartum fever[J]. Journal of Clinical Anesthesiology, 2019, 35(4):327-330. doi:10.12089/jca.2019.04.004.
[18]	CHEN X, ZHANG Y, NI X, et al. Effects of labour analgesia with different concentrations of ropivacaine on maternal body temperature and inflammatory factor:a randomised controlled study[J]. Anaesth Crit Care Pain Med, 2022, 41(2):101030. doi:10.1016/j.accpm.2022.101030.
[19]	CORNET M C, KUZNIEWICZ M W, SCHEFFLER A W, et al. Epidural analgesia during labor and neonatal hypoxic-ischemic encephalopathy[J]. JAMA Netw Open, 2024, 7(9):e2433730. doi:10.1001/jamanetworkopen.2024.33730.
[20]	ARCE D Y, BELLAVIA A, CANTONWINE D E, et al. Average and time-specific maternal prenatal inflammatory biomarkers and the risk of labor epidural associated fever[J]. PLoS One, 2019, 14(11):e0222958. doi:10.1371/journal.pone.0222958.
[21]	CALLAHAN E C, LEE W, ALESHI P, et al. Modern labor epidural analgesia:implications for labor outcomes and maternal-fetal health[J]. Am J Obstet Gynecol, 2023, 228(5S):S1260-S1269. doi:10.1016/j.ajog.2022.06.017.

组别		n	年龄/岁		产前体温/℃		心率/（次/min）
对照组		160	28.57±3.45		36.48±0.14		85.18±9.93
A组		55	28.47±3.21		36.50±0.14		86.27±10.11
B组		25	29.36±3.90		36.50±0.14		86.20±9.77
F			0.644		0.629		0.308
组别	SBP/mmHg			DBP/mmHg		BMI/（kg/m²）		孕周/周
对照组	120.30±8.11			76.93±6.61		25.66±2.94		39.64±0.93
A组	121.07±8.07			77.02±6.56		26.26±3.25		38.99±5.31
B组	119.32±8.12			76.48±7.05		26.65±2.96		39.70±0.92
F	0.423			0.060		1.300		0.355

组别		n	年龄/岁		产前体温/℃		心率/（次/min）
对照组		160	28.57±3.45		36.48±0.14		85.18±9.93
A组		55	28.47±3.21		36.50±0.14		86.27±10.11
B组		25	29.36±3.90		36.50±0.14		86.20±9.77
F			0.644		0.629		0.308
组别	SBP/mmHg			DBP/mmHg		BMI/（kg/m²）		孕周/周
对照组	120.30±8.11			76.93±6.61		25.66±2.94		39.64±0.93
A组	121.07±8.07			77.02±6.56		26.26±3.25		38.99±5.31
B组	119.32±8.12			76.48±7.05		26.65±2.96		39.70±0.92
F	0.423			0.060		1.300		0.355

组别	n		分娩镇痛开始至分娩时间/h		破膜至分娩时间/h		分娩方式
组别	n		分娩镇痛开始至分娩时间/h		破膜至分娩时间/h		阴道分娩		剖宫产
对照组	160		5.13±3.24		7.39±6.10		144（90.0）		16（10.0）
A组	55		7.61±2.48^a		9.53±5.76^a		44（80.0）		11（20.0）
B组	25		7.37±2.27^a		9.16±5.55^a		19（76.0）		6（24.0）
F或χ²			17.284^＊		3.085^＊		5.119
组别		临产方式				破膜方式
组别		自然临产		催产素引产		自然破膜		人工破膜
对照组		109（68.1）		51（31.0）		153（95.6）		7（4.4）
A组		31（56.4）		24（43.6）		54（98.2）		1（1.8）
B组		16（64.0）		9（36.0）		25（100.0）		0（0.0）
χ²		2.501				1.793

组别	n		分娩镇痛开始至分娩时间/h		破膜至分娩时间/h		分娩方式
组别	n		分娩镇痛开始至分娩时间/h		破膜至分娩时间/h		阴道分娩		剖宫产
对照组	160		5.13±3.24		7.39±6.10		144（90.0）		16（10.0）
A组	55		7.61±2.48^a		9.53±5.76^a		44（80.0）		11（20.0）
B组	25		7.37±2.27^a		9.16±5.55^a		19（76.0）		6（24.0）
F或χ²			17.284^＊		3.085^＊		5.119
组别		临产方式				破膜方式
组别		自然临产		催产素引产		自然破膜		人工破膜
对照组		109（68.1）		51（31.0）		153（95.6）		7（4.4）
A组		31（56.4）		24（43.6）		54（98.2）		1（1.8）
B组		16（64.0）		9（36.0）		25（100.0）		0（0.0）
χ²		2.501				1.793

组别		n	产后2 h出血量/mL		第一产程时长/h
对照组		144	150（150,180）		7.40±2.43
A组		44	180（150，250）^a		9.88±2.63^a
B组		19	150（150，300）		9.43±3.26^a
F或H			19.914^＊＊		18.686^＊＊
组别	第二产程时长/h			第三产程时长/h		总产程时长/h
对照组	0.50±0.25			0.10±0.06		8.00±2.52
A组	0.70±0.38^a			0.09±0.04		10.67±2.74^a
B组	0.49±0.36^b			0.09±0.04		10.00±2.52^b
F	7.493^＊			0.278		19.420^＊＊