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Epidurals Can Cause Fever

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These are easy to read and understand and are beautifully presented.

Here are two of the abstracts which I found in Henci Goer's "Obstetric Myths...":

1. Fusi L. et al. Maternal pyrexia associated with the use of epidural analgesia in labour. Lancet, Jun 3, 1989; 1250-1252.

Fifteen healthy women in spontaneous labor who had no evidence of infection and used pethidine (a narcotic) for pain relief were compared with a similar group of 18 women who had epidurals. Temperatures were taken both orally and vaginally. The body temperature of the pethidine group remained constant; the vaginal temperature of the epidural group rose roughly 1 degree centigrade every 7 hours (p<0.001). Vaginal and oral temperatures correlated.

2. Macaulay JH, et al. Epidural analgesia in labor and fetal hyperthermia. Obstet Gynecol 1992; 80(4): 665-669.

An intrauterine probe was used to measure uterine wall and fetal skin temperature in laboring women, of whom 33 had epidurals and 24 used other methods of pain control. Maternal oral temperatures were also taken. Only two women had oral temperatures over 37.5 degrees C, but uterine temperatures rose above this point in 45% of the epidural versus 8% of the nonepidural group. Among the fetuses, 30%, all from the epidural group, had skin temperatures over 38 degrees C. Maximum fetal skin temperature correlated with time since epidural induction (p=0.012), but there was no correlation with time in the nonepidural group. Anesthetic dosage also did not correlate with temperature. An estimated 5% of fetuses reached a core temperature more than 40 degrees C, all in association with an epidural. "(T)he fetus whose mother has a long labor using epidural analgesia in a hot environment may reach a temperature at which heat-induced neurologic injury can occur."

Related mention in: Pello LC et al. Computerized fetal heart rate analysis in labor. Obstet Gynecol 1991; 78: 602 

Epidurals are already known to increase maternal core temperature but the physiologic pathways is not certain. It is most likely a blockade of the sympathetic nervous system so that the epidural analgesia limits perspiration (blocks skin's ability to regulate heat) and removes the stimulus for hyperventilation (ways our body get rid of heat). If the mother has a fever the fetus' body temperature rises as well. In cases of prolonged labor (as is found in epidural labors), cesarean section and induction newborn sepsis/infection is often suspected when there is a rise in the newborn's temperature. This results in testing, often invasive, increases separation from mother, delay in breastfeeding, longer hospital stays, etc. the proverbial "can of worms". Supposedly if the newborn's fever is very high it can affect their own ability to cope and can cause other problems. This isn't an extremely well researched area yet. But here is what I found in my files.

Here are some articles that address fever and epidurals:

Macaulay, Bond and Steer. Epidural Analgesia in Labor and Fetal Hyperthermia, Obstetrics & Gynecology, Vol. 80, No.4, 1992, pp 665-669.

Vinson, Thomas and Kiser. Association Between Epidural Analgesia During Labor and Fever, the Journal of Family Practice, Vol. 36, No. 6, 1993, pp 617-622.

Fusi et al. Maternal pyrexia associated with the use of epidural analgesia in labour, Lancet, June 3, 1989, pp 1250-1252

Herbst, Wolner-Hanssen and Ingemarsson. Risk Factors for Fever in Labor, Obstetrics & Gynecology, 1995, Vol 86, pp.790-794. 

This Web page is referenced from another page containing related information about Epidurals and Other Drugs


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