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. 1999 Apr;89(4):506–510. doi: 10.2105/ajph.89.4.506

Maternal intrapartum temperature elevation as a risk factor for cesarean delivery and assisted vaginal delivery.

E Lieberman 1, A Cohen 1, J Lang 1, F Frigoletto 1, L Goetzl 1
PMCID: PMC1508894  PMID: 10191792

Abstract

OBJECTIVES: This study investigated the association of intrapartum temperature elevation with cesarean delivery and assisted vaginal delivery. METHODS: Participants were 1233 nulliparous women with singleton, term pregnancies in vertex presentations who had spontaneous labors and were afebrile (temperature: 99.5 degrees F [37.5 degrees C]) at admission for delivery. Rates of cesarean and assisted vaginal deliveries according to highest intrapartum temperature were examined by epidural status. RESULTS: Women with maximum intrapartum temperatures higher than 99.5 degrees F were 3 times as likely to experience cesarean (25.2% vs 7.2%) or assisted vaginal delivery (25.2% vs 8.5%). The association was present in epidural users and nonusers and persisted after birthweight, epidural use, and labor length had been controlled. In adjusted analyses, temperature elevation was associated with a doubling in the risk of cesarean delivery (odds ratio [OR] = 2.3, 95% confidence interval [CI] = 1.5, 3.4) and assisted vaginal delivery (OR = 2.1, 95% CI = 1.4, 3.1). CONCLUSIONS: Modest temperature elevation developing during labor was associated with higher rates of cesarean and assisted vaginal deliveries. More frequent temperature elevation among women with epidural analgesia may explain in part the higher rates of cesarean and assisted vaginal deliveries observed with epidural use.

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Selected References

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  1. Camann W. R., Hortvet L. A., Hughes N., Bader A. M., Datta S. Maternal temperature regulation during extradural analgesia for labour. Br J Anaesth. 1991 Nov;67(5):565–568. doi: 10.1093/bja/67.5.565. [DOI] [PubMed] [Google Scholar]
  2. De Jongh R. F., Bosmans E. P., Puylaert M. J., Ombelet W. U., Vandeput H. J., Berghmans R. A. The influence of anaesthetic techniques and type of delivery on peripartum serum interleukin-6 concentrations. Acta Anaesthesiol Scand. 1997 Aug;41(7):853–860. doi: 10.1111/j.1399-6576.1997.tb04800.x. [DOI] [PubMed] [Google Scholar]
  3. Duff P., Sanders R., Gibbs R. S. The course of labor in term patients with chorioamnionitis. Am J Obstet Gynecol. 1983 Oct 15;147(4):391–395. doi: 10.1016/s0002-9378(16)32231-1. [DOI] [PubMed] [Google Scholar]
  4. Frigoletto F. D., Jr, Lieberman E., Lang J. M., Cohen A., Barss V., Ringer S., Datta S. A clinical trial of active management of labor. N Engl J Med. 1995 Sep 21;333(12):745–750. doi: 10.1056/NEJM199509213331201. [DOI] [PubMed] [Google Scholar]
  5. Fusi L., Steer P. J., Maresh M. J., Beard R. W. Maternal pyrexia associated with the use of epidural analgesia in labour. Lancet. 1989 Jun 3;1(8649):1250–1252. doi: 10.1016/s0140-6736(89)92341-6. [DOI] [PubMed] [Google Scholar]
  6. Gibbs R. S., Castillo M. S., Rodgers P. J. Management of acute chorioamnionitis. Am J Obstet Gynecol. 1980 Mar 15;136(6):709–713. doi: 10.1016/0002-9378(80)90445-7. [DOI] [PubMed] [Google Scholar]
  7. Hawkins J. L., Gibbs C. P., Orleans M., Martin-Salvaj G., Beaty B. Obstetric anesthesia work force survey, 1981 versus 1992. Anesthesiology. 1997 Jul;87(1):135–143. doi: 10.1097/00000542-199707000-00018. [DOI] [PubMed] [Google Scholar]
  8. Hawkins J. L., Hess K. R., Kubicek M. A., Joyce T. H., 3rd, Morrow D. H. A reevaluation of the association between instrument delivery and epidural analgesia. Reg Anesth. 1995 Jan-Feb;20(1):50–56. [PubMed] [Google Scholar]
  9. Herbst A., Wølner-Hanssen P., Ingemarsson I. Risk factors for fever in labor. Obstet Gynecol. 1995 Nov;86(5):790–794. doi: 10.1016/0029-7844(95)00254-O. [DOI] [PubMed] [Google Scholar]
  10. Koh K. S., Chan F. H., Monfared A. H., Ledger W. J., Paul R. H. The changing perinatal and maternal outcome in chorioamnionitis. Obstet Gynecol. 1979 Jun;53(6):730–734. [PubMed] [Google Scholar]
  11. Lieberman E., Lang J. M., Cohen A., D'Agostino R., Jr, Datta S., Frigoletto F. D., Jr Association of epidural analgesia with cesarean delivery in nulliparas. Obstet Gynecol. 1996 Dec;88(6):993–1000. doi: 10.1016/s0029-7844(96)00359-6. [DOI] [PubMed] [Google Scholar]
  12. Lieberman E., Lang J. M., Frigoletto F., Jr, Richardson D. K., Ringer S. A., Cohen A. Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. Pediatrics. 1997 Mar;99(3):415–419. doi: 10.1542/peds.99.3.415. [DOI] [PubMed] [Google Scholar]
  13. Macaulay J. H., Bond K., Steer P. J. Epidural analgesia in labor and fetal hyperthermia. Obstet Gynecol. 1992 Oct;80(4):665–669. [PubMed] [Google Scholar]
  14. Macaulay J. H., Randall N. R., Bond K., Steer P. J. Continuous monitoring of fetal temperature by noninvasive probe and its relationship to maternal temperature, fetal heart rate, and cord arterial oxygen and pH. Obstet Gynecol. 1992 Mar;79(3):469–474. doi: 10.1097/00006250-199203000-00029. [DOI] [PubMed] [Google Scholar]
  15. Mercier F. J., Benhamou D. Hyperthermia related to epidural analgesia during labor. Int J Obstet Anesth. 1997 Jan;6(1):19–24. doi: 10.1016/s0959-289x(97)80047-7. [DOI] [PubMed] [Google Scholar]
  16. Paterson C. M., Saunders N. S., Wadsworth J. The characteristics of the second stage of labour in 25,069 singleton deliveries in the North West Thames Health Region, 1988. Br J Obstet Gynaecol. 1992 May;99(5):377–380. doi: 10.1111/j.1471-0528.1992.tb13752.x. [DOI] [PubMed] [Google Scholar]
  17. Ramin S. M., Gambling D. R., Lucas M. J., Sharma S. K., Sidawi J. E., Leveno K. J. Randomized trial of epidural versus intravenous analgesia during labor. Obstet Gynecol. 1995 Nov;86(5):783–789. doi: 10.1016/0029-7844(95)00269-w. [DOI] [PubMed] [Google Scholar]
  18. Saper C. B., Breder C. D. The neurologic basis of fever. N Engl J Med. 1994 Jun 30;330(26):1880–1886. doi: 10.1056/NEJM199406303302609. [DOI] [PubMed] [Google Scholar]
  19. Satin A. J., Maberry M. C., Leveno K. J., Sherman M. L., Kline D. M. Chorioamnionitis: a harbinger of dystocia. Obstet Gynecol. 1992 Jun;79(6):913–915. [PubMed] [Google Scholar]
  20. Sharma S. K., Sidawi J. E., Ramin S. M., Lucas M. J., Leveno K. J., Cunningham F. G. Cesarean delivery: a randomized trial of epidural versus patient-controlled meperidine analgesia during labor. Anesthesiology. 1997 Sep;87(3):487–494. doi: 10.1097/00000542-199709000-00006. [DOI] [PubMed] [Google Scholar]
  21. Thorp J. A., Breedlove G. Epidural analgesia in labor: an evaluation of risks and benefits. Birth. 1996 Jun;23(2):63–83. doi: 10.1111/j.1523-536x.1996.tb00833.x. [DOI] [PubMed] [Google Scholar]
  22. Thorp J. A., Eckert L. O., Ang M. S., Johnston D. A., Peaceman A. M., Parisi V. M. Epidural analgesia and cesarean section for dystocia: risk factors in nulliparas. Am J Perinatol. 1991 Nov;8(6):402–410. doi: 10.1055/s-2007-999426. [DOI] [PubMed] [Google Scholar]
  23. Thorp J. A., Hu D. H., Albin R. M., McNitt J., Meyer B. A., Cohen G. R., Yeast J. D. The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial. Am J Obstet Gynecol. 1993 Oct;169(4):851–858. doi: 10.1016/0002-9378(93)90015-b. [DOI] [PubMed] [Google Scholar]
  24. Thorp J. A., Parisi V. M., Boylan P. C., Johnston D. A. The effect of continuous epidural analgesia on cesarean section for dystocia in nulliparous women. Am J Obstet Gynecol. 1989 Sep;161(3):670–675. doi: 10.1016/0002-9378(89)90377-3. [DOI] [PubMed] [Google Scholar]
  25. Vinson D. C., Thomas R., Kiser T. Association between epidural analgesia during labor and fever. J Fam Pract. 1993 Jun;36(6):617–622. [PubMed] [Google Scholar]

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