Association between epidural analgesia and intrapartum fever

The objective of this paper is to determine whether or not epidural analgesia is an independent risk factor for intrapartum fever. Maternal temperature was measured every 4 h during labor to 1004 consecutive women in term labor. Women with fever or on antibiotics were excluded. Epidural analgesia was administered upon patients' request. Of the 406 (40%) women who received epidural analgesia, 11.8% (n = 48) developed a fever greater than or equal to 37.8 degrees C during labor compared with only 0.2% (n = 1) of women not receiving epidural analgesia. Women who received epidural analgesia were more likely to have one or more risk factors for intrapartum infection. Their labor and ruptured membranes were longer, they were more likely to have internal monitoring and have more vaginal examinations. Compared with women who received epidural analgesia and did not develop intrapartum fever, women that did develop fever had longer epidurals and more risk factors for infection. However, in a logistic regression analysis with fever as dependent variable, only the duration of epidural was significantly associated with the occurrence of fever. The rate of fever increased with longer labors, from 5% with labor < 3 h to 28% with labor > 6 h. In 90% of women the fever resolved within a few hours after delivery. Sepsis evaluation was negative in all of the newborns to mother who had intrapartum fever. Our data support a noninfectious etiology for intrapartum fever in the vast majority of our patients. However, infection must be ruled out before a decision is made to withhold antibiotic therapy.