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Intrapartum Epidural Analgesia and Maternal Temperature Regulation

Goetzl, Laura MD, MPH; Rivers, Jose MD; Zighelboim, Israel MD; Wali, Ashutosh MD; Badell, Martina MD; Suresh, Maya S. MD

doi: 10.1097/01.AOG.0000255976.14297.f6
Original Research

OBJECTIVE: To examine maternal temperature changes after epidural analgesia.

METHODS: A prospective cohort of nulliparas at term was monitored with hourly maternal tympanic temperatures after epidural analgesia (n=99). Temperature response after epidural analgesia was examined in the group as a whole. Subsequently, mean maternal temperature curves were compared between women who remained afebrile throughout labor (n=77) and women who developed intrapartum fever with body temperature greater than 100.4ºF (n=22). Baseline maternal characteristics were assessed.

RESULTS: Women who later developed intrapartum fever had a higher mean temperature within 1 hour after epidural analgesia. In contrast, women who remained afebrile had no increase in core temperature. During the first 4 hours after epidural analgesia initiation, women who later develop intrapartum fever have an increase in mean tympanic temperature of 0.33ºF per hour.

CONCLUSION: Epidural analgesia is not associated with increased temperature in the majority of women. Hyperthermia is an abnormal response confined to a minority subset, which occurs immediately after exposure. Our findings do not support a universal perturbation of maternal thermoregulation after epidural analgesia.

LEVEL OF EVIDENCE: II

Hyperthermia after epidural analgesia is not due to uniform perturbations of thermoregulation; rather, it is an abnormal response confined to a minority subset.

From the 1Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina; 2Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri; 3Department of Anesthesiology, Baylor College of Medicine, Houston, Texas; and 4Department of Obstetrics and Gynecology, Emory University, Atlanta, Georgia.

This study was supported by the National Institute of Child Health and Human Development, grant no. 1K12HD01426-01, and by the Berlex Foundation Scholar Award in Clinical Research.

Corresponding author: Laura Goetzl, MD, MPH, Department of Obstetrics & Gynecology, MUSC, 96 Jonathan Lucas Street, CSB 634, Charleston, SC 29425; e-mail: goetzl@musc.edu.

© 2007 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.