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Epidural Fevers

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Maternal pyrexia associated with the use of epidural analgesia in labour.

Fusi L et al.
Lancet, June 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 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 seven hours (p < 0.001). Vaginal and oral temperatures correlated. In the mother, pyrexia [fever], even in the absence of uterine infection, can lead to hypertonic [overly contracted] uterus, hypotension, tachycardia [rapid heartbeat], and metabolic acidosis. Maternal fever can cause fever in the fetus, leading to tachycardia, and reduced ability to adapt to the stress of labor [also separation from the mother after birth and a septic workup to rule out infection]. Persistent fetal fever can lead to hypotension and acidosis.

Epidural analgesia in labor and fetal hyperthermia

Macaulay JH, Bond K and Steer PJ.
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 deg. 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 deg. 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 deg. 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."

Date: 97-03-10 22:48:37 EST
.c The Associated Press
CHICAGO (AP) - Epidural anesthesia, commonly used during childbirth, is strongly linked to fevers in mothers that may lead to unnecessary tests and treatment for their newborns, a study suggests.

Fevers in women undergoing labor can signal an infection that may be passed on to their babies, in whom it can be life-threatening. Newborns whose mothers had a fever of 100.4 or higher are routinely given blood tests and antibiotics as a precaution.

However, a new study bolsters previous research suggesting that epidural anesthesia can cause non-infectious fevers that pose no risk to newborns.

The study, published in the March issue of the journal Pediatrics, found that babies whose mothers had epidurals were no more likely than other newborns to have infections.

Newborns who are thought to have sepsis, or a bacterial infection, typically have their blood drawn and are given antibiotics intravenously for two days, or until the tests results are available, said Dr. Ellice Lieberman, a Boston epidemiologist who conducted the study with colleagues at Brigham and Women's Hospital.

This may prolong their stay in the hospital, unduly upset their parents and expose the child to pain and other risks, the researchers wrote.

Antibiotics themselves, in rare cases, can cause side effects such as kidney damage or hearing loss in newborns, Lieberman said. Overuse of antibiotics also can lead to drug-resistant forms of bacteria.

Such concerns led the Elk Grove Village, Ill.-based American Academy of Pediatrics, which publishes the journal, to issue new guidelines for preventing sepsis. The guidelines were published in the March issue.

Lieberman and colleagues studied 1,047 women who received an epidural - a spinal injection to numb the lower body - and 610 who did not. Fourteen percent of the women in the epidural group developed fevers during labor, compared with just 1 percent of the others.

Newborns in the epidural group were four times more likely to be tested and treated with antibiotics than those in the second group, although they were not more likely to develop bacterial infections.

The authors said doctors should consider using a higher maternal fever threshold before treating newborns. They also said more study is needed on ways to limit epidural-related fevers in pregnant women.

Lieberman did not know how many of the estimated 4 million babies born annually in this country are products of epidural births, although about 60 percent of the women she studied underwent the procedure.

Her findings present a dilemma for doctors trying to balance the risk of infection with the risks and costs of treatment, said Dr. William Oh, chairman of the academy's committee on fetus and newborn.

Oh noted that the academy's new guidelines include a recommendation not to treat newborns of mothers with fevers if the babies appear healthy and the mothers receive at least two doses of penicillin during childbirth.

In such cases, the infants should be watched closely for several days but do not need tests or antibiotics if there is no sign of infection, Oh said.

Epidurals May Affect Newborns

Epidurals, maternal fever, and neonatal sepsis evaluation.

Lieberman, et al. (March 1997).
Pediatrics, 89 (3), 415-419.
Chicago - Women who receive epidurals to ease labor pains may be increasing discomfort for their newborns, according to a study published in this month's Pediatrics, the Journal of the American Academy of Pediatrics. The new study says that epidurals can cause fevers in mothers during childbirth, which in turn, causes doctors to test newborns for blood and tissue infections (sepsis), and to treat the newborns with antibiotics. The study's authors come from Brigham and Women's Hospitals and the Joint Program in Neonatology, Harvard Medical School, Boston. The authors looked at 1,047 women who received epidural analgesia for pain relief during labor. More than 14 percent of these women developed fevers during labor. Of the babies born to those 1,047 women, 34 percent needed an evaluation for sepsis, as compared to less than 10 percent of babies born to mothers who had no epidural. Newborns whose mothers had received an epidural were four times as likely to be treated with antibiotics because doctors were concerned about the possibility of sepsis. However, babies of women who received an epidural were not more likely to actually have infections, which was very rare in both groups. The authors conclude that women and their doctors should discuss the possible consequences of fever resulting from epidural use when deciding what method of pain relief to use during labor.

Newborn Lumbar Puncture

One of the side effects of maternal fever can be infant fever. And if your newborn has a fever, one of the first things they suspect is Spinal Meningitis. The way the diagnosed Spinal Meningitis is by doing a lumbar puncture. My son did contract Spinal Meningitis at 24 hours old. I had to stand outside the room while they did a lumbar puncture on my newborn son (bent him over in half, screaming..and stuck a needle in his spine to remove some of the fluid to test it). It is a huge deal. And all I could think was....here I am..had this big 10 baby w/o any needle sticks & not circumcising him to avoid unnecessary pain...and here he is being stuck in his back. And while they were waiting for the cultures to grow, they go ahead & treated him with 3 very powerful antibiotics, which could have caused him to go deaf. We had to sign a consent form, acknowledging this risk. He's almost 3 yrs old and to this day, every time I think about what that baby went through, it upsets me.

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


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