Sophie Jansen1, Enrico Lopriore2, Christiana Naaktgeboren3, Marieke Sueters4, Jacqueline Limpens5, Elisabeth van Leeuwen6, Vincent Bekker2,7. 1. Department of Neonatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands, s.j.jansen@lumc.nl. 2. Department of Neonatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands. 3. University Medical Center Utrecht (UMCU), Department of Data Management and Research Support, Julius Center for Health Science and Primary Care, Utrecht, The Netherlands. 4. Department of Obstetrics and Gynecology, Leiden University Medical Center (LUMC), Leiden, The Netherlands. 5. Medical Library, Research Support, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands. 6. Department of Obstetrics and Gynecology, Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands. 7. Center for Infection and Immunity Amsterdam (CINIMA), Emma Children's Hospital, Amsterdam University Medical Center (UMC), Amsterdam, The Netherlands.
Abstract
BACKGROUND: While epidural analgesia (EA) is associated with maternal fever during labor, the impact on the risk for maternal and/or neonatal sepsis is unknown. OBJECTIVES: The aim of this systematic review was to investigate the effect of epidural-related intrapartum fever on maternal and neonatal outcomes. METHODS: OVID MEDLINE, OVID Embase, the Cochrane Library, Cochrane Controlled Register of Trials, and clinical trial registries were searched for randomized controlled trials (RCT) and observational cohort studies from inception to November 2018. A total of 761 studies were identified with 100 eligible for full-text review. Only articles investigating the relationship between EA and maternal fever during labor were eligible for inclusion. Study quality was assessed using the Cochrane's Risk of Bias tool and National Institute of Health Quality Assessment Tool. Two meta-analyses - one each for the RCT and observational cohort groups - were performed using the random-effects model of Mantel-Haenszel to produce summary risk ratios (RR) with 95% CI. RESULTS: Twelve RCTs and 16 observational cohort studies involving 579,157 parturients were included. RRs for maternal fever for the RCT and cohort analyses were 3.54 (95% CI 2.61-4.81) and 5.60 (95% CI 4.50-6.97), respectively. Meta-analyses of RR for maternal infection in both groups were infeasible given few occurrences. Meta-analysis of data from observational studies showed an increased risk for maternal antibiotic treatment in the epidural group (RR 2.60; 95% CI 1.31-5.17). For both analyses, neonates born to women with an epidural were not evaluated more often for suspected sepsis. Neither analysis reported an increased rate of neonatal bacteremia or neonatal antibiotic treatment after EA, although data precluded conclusiveness. CONCLUSION: EA increases the risk of intrapartum fever and maternal antibiotic treatment. However, a definite conclusion on whether EA increases the risk for a proven maternal and/or neonatal bacteremia cannot be drawn due to the low quality of data. Further research on whether epidural-related intrapartum fever is of infectious origin or not is therefore needed.
BACKGROUND: While epidural analgesia (EA) is associated with maternal fever during labor, the impact on the risk for maternal and/or neonatal sepsis is unknown. OBJECTIVES: The aim of this systematic review was to investigate the effect of epidural-related intrapartum fever on maternal and neonatal outcomes. METHODS: OVID MEDLINE, OVID Embase, the Cochrane Library, Cochrane Controlled Register of Trials, and clinical trial registries were searched for randomized controlled trials (RCT) and observational cohort studies from inception to November 2018. A total of 761 studies were identified with 100 eligible for full-text review. Only articles investigating the relationship between EA and maternal fever during labor were eligible for inclusion. Study quality was assessed using the Cochrane's Risk of Bias tool and National Institute of Health Quality Assessment Tool. Two meta-analyses - one each for the RCT and observational cohort groups - were performed using the random-effects model of Mantel-Haenszel to produce summary risk ratios (RR) with 95% CI. RESULTS: Twelve RCTs and 16 observational cohort studies involving 579,157 parturients were included. RRs for maternal fever for the RCT and cohort analyses were 3.54 (95% CI 2.61-4.81) and 5.60 (95% CI 4.50-6.97), respectively. Meta-analyses of RR for maternal infection in both groups were infeasible given few occurrences. Meta-analysis of data from observational studies showed an increased risk for maternal antibiotic treatment in the epidural group (RR 2.60; 95% CI 1.31-5.17). For both analyses, neonates born to women with an epidural were not evaluated more often for suspected sepsis. Neither analysis reported an increased rate of neonatal bacteremia or neonatal antibiotic treatment after EA, although data precluded conclusiveness. CONCLUSION: EA increases the risk of intrapartum fever and maternal antibiotic treatment. However, a definite conclusion on whether EA increases the risk for a proven maternal and/or neonatal bacteremia cannot be drawn due to the low quality of data. Further research on whether epidural-related intrapartum fever is of infectious origin or not is therefore needed.
Authors: Anna Cartledge; Daniel Hind; Mike Bradburn; Marrissa Martyn-St James; Sophie Davenport; Wei Shao Tung; Hwu Yung; Jeyinn Wong; Matthew Wilson Journal: Br J Anaesth Date: 2022-08-05 Impact factor: 11.719