Retrospective analysis of hyperthermia associated with epidural analgesia and its relationship with labor progression and delivery mode
Objective: To investigate the association between hyperthermia during labor and the use of epidural analgesia (EA), identify the risk factors for its occurrence, and analyze the impact of EA on labor progression and delivery methods. Materials and methods: This study included 1874 delivery records from January 1 to June 31, 2021, at D.D. Pletnev City Clinical Hospital in Moscow. Among these, 956 involved EA, whereas 918 did not use neuraxial anesthesia. The study categorized cases based on temperature elevation (temperature ≥37°C and <37.5°C, indicative of hyperthermia tendency; temperature ≥37.5°C, hyperthermia) and delivery type (vaginal delivery (VD) and cesarean section (CS)). Patients who gave birth with EA and a temperature <37.5°C (877/956) constituted subgroup A, whereas those with a temperature ≥37.5°C (79/956) belonged to subgroup B. A comparative analysis of patient history, one-way correlation analysis, and analysis of variance were conducted to identify factors predisposing patients to hyperthermia. Results: The analysis revealed a statistically significant association between the use of EA for pain relief during labor and the occurrence of hyperthermia. Specifically, 97.53% (79/81) of hyperthermia cases were recorded in patients who received EA (95% CI:93.31–99.23, p<0.001). Predisposing factors included the duration of labor, interval between anesthetic administration, number of vaginal examinations (all p<0.001), amniotic fluid characteristics (p=0.001), and cervical dilation at the time of analgesia (p=0.002). Hyperthermia in the presence of EA was associated with a higher risk of operative delivery, with emergency CS performed 2.5 times more frequently (30.4% (24/79) vs. 12.2% (107/877), p<0.001) and vacuum-assisted fetal extraction performed 2.9 times more frequently (10.1% (8/79) vs. 3.5% (31/877), p=0.003) in subgroup B than in subgroup A. The most common indication for surgery was fetal distress, (patients with EA and a body temperature of 37.5°C or higher were 2.6 times more likely to have fetal distress than in those without hyperthermia (29.1% (23/79) and 11.4% (100/877), p <0.001). Conclusion: Early and prolonged EA is associated with an increased risk of hyperthermia, operative delivery, and adverse perinatal outcomes. Optimizing the application of this form of labor pain relief can enhance the quality of obstetric care. Authors' contributions: Podzolkova N.M., Denisova Yu.V. – conception and design of the study, Denisova Yu.V., Gerasimov A.N. – data collection and processing; Gerasimov A.N., Denisova Yu.V. – statistical analysis; Denisova Yu.V. – drafting of the manuscript; Podzolkova N.M., Denisova T.V. – editing. Conflicts of interest: The authors have no conflicts of interest to declare. Funding: There was no funding for this study. Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the Russian Medical Academy for Continuing Professional Education, Ministry of Health of Russia. Patient Consent for Publication: All patients provided informed consent for the publication of their data. Authors' Data Sharing Statement: The data supporting the findings of this study are available on request from the corresponding author after approval from the principal investigator. For citation: Podzolkova N.M., Denisova Yu.V., Gerasimov A.N., Denisova T.V. Retrospective analysis of hyperthermia associated with epidural analgesia and its relationship with labor progression and delivery mode. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (9): 129-138 (in Russian) https://dx.doi.org/10.18565/aig.2023.32Podzolkova N.M., Denisova Yu.V., Gerasimov A.N., Denisova T.V.
Keywords
retrospective analysis
epidural analgesia
hyperthermia
cesarean section
vacuum extraction delivery
fetal distress
References
- Адамян Л.В., Артымук Н.В., Белокриницкая Т.Е., Куликов А.В., Овезов А.М., Петрухин В.А., Проценко Д.Н., Упрямова Е.Ю., Филиппов О.С., Шифман Е.М. Нейроаксиальные методы обезболивания родов. Клинические рекомендации. Анестезиология и реаниматология. 2018; 5: 99‑110. [Adamyan L.V., Artymuk N.V., Belokrinitskaia T.E., Kulikov A.V., Ovezov A.M., Petrukhin V.A., Protsenko D.N., Upriamova E.Iu., Filippov O.S., Shifman E.M. Neuroxial methods of labor analgesia. Clinical guidelines. Russian Journal of Anaesthesiology and Reanimatology. 2018; (5): 99‑110. (in Russian)]. https://dx.doi.org/10.17116/anaesthesiology201805199.
- Zanfini В.А., Catarci S., Vassalli F., Longo V.L., Biancone M., Carducci B. et al. The effect of epidural analgesia on labour and neonatal and maternal outcomes in 1, 2a, 3, and 4a robson's classes: a propensity score-matched analysis. J. Clin. Med. 2022; 11(20): 6124. https://dx.doi.org/10.3390/jcm11206124.
- Yagi T., Kinose Y., Bun M., Horai M., Matsuda C., Miyake T. et al. Obstetrical outcomes of labor with and without analgesia in Robson classification groups 1 and 2a: a single-center retrospective study. J. Anesth. 2023; 37(1): 39-48.https://dx.doi.org/10.1007/s00540-022-03125-9.
- Khanna P., Jain S., Thariani K., Sharma S., Singh A.K. Epidural fever: hiding in the shadows. Turk. J. Anaesthesiol. Reanim. 2020; 48(5): 350-5.https://dx.doi.org/10.5152/TJAR.2020.50.
- Axelrod Y.K., Diringer M.N. Temperature management in acute neurologic disorders. Neurol. Clin. 2008; 26(2): 585-603. https://dx.doi.org/10.1016/j.ncl.2008.02.005.
- Laupland K.B. Fever in the critically ill medical patient. J. Crit. Care Med. 2009; 37(7Suppl.): S273-8. https://dx.doi.org/10.1097/CCM.0b013e3181aa6117.
- Royal College of Obstetricians and Gynaecologists. Green–top Guideline № 64a. Bacterial sepsis in pregnancy. 2012. Available at: https://www.rcog.org.uk/en/guidelines-researchservices/guidelines/gtg64a/.Accessed 19 November 2022.
- Fusi L., Steer P.J., Maresh M.J., Beard R.W. Maternal pyrexia associated with the use of epidural analgesia in labour. Lancet. 1989; 1(8649): 1250-2.https://dx.doi.org/10.1016/s0140-6736(89)92341-6.
- Герасимов А.Н., Морозова Н.И. Параметрические и непараметрические методы в медицинской статистике. Эпидемиология и вакцинопрофилактика. 2015; 14(5): 6‑12. [Gerasimov A.N., Morozova N.I. Parametric and non-parametric methods in medical statistics. Epidemiology and Vaccinal Prevention. 2015; 14(5): 6‑12. (in Russian)]. https://dx.doi.org/10.31631/2073-3046-2015-14-5-6-12.
- Sultan P., David A.L., Fernando R., Ackland G.L. Inflammation and epidural-related maternal fever: proposed mechanisms. Anesth. Analg. 2016; 122(5): 1546-53. https://dx.doi.org/10.1213/ANE.0000000000001195.
- Wohlrab P., Boehme S., Kaun C., Wojta J., Spittler A., Saleh L. et al. Ropivacaine activates multiple proapoptotic and inflammatory signaling pathways that might subsume to trigger epidural-related maternal fever. Anesth. Analg. 2020; 130(2): 321-31. https://dx.doi.org/10.1213/ANE.0000000000004402.
- Kaufner L., Niggemann P., Baum T., Casu S., Sehouli J., Bietenbeck A. et al. Impact of brief prewarming on anesthesia-related core-temperature drop, hemodynamics, microperfusion and postoperative ventilation in cytoreductive surgery of ovarian cancer: a randomized trial. BMC Anesthesiology. 2019; 19(1): 161. https://dx.doi.org/10.1186/s12871-019-0828-1.
- Negishi C., Lenhardt R., Sessler D.I., DeWitte J., Ikeda T., Kurz A., Lobo E. Desflurane reduces the febrile response to administration of interleukin-2. Anesthesiology. 1998; 88(5): 1162-9. https://dx.doi.org/10.1097/00000542-199805000-00005.
- Kurz A., Go J.C., Sessler D.I., Kaer K., Larson M.D., Bjorksten A.R. Alfentanil slightly increases the sweating threshold and markedly reduces the vasoconstriction and shivering thresholds. Anesthesiology. 1995; 83(2): 293-9. https://dx.doi.org/10.1097/00000542-199508000-00009.
- Шифман Е.М., Гуменюк Е.Г., Шакурова Е.Ю. Эпидуральная анальгезия и лихорадка в родах. Общая реаниматология. 2008; 4(5): 55. [Shifman Ye.M., Gumenyuk Ye.G., Shakurova Ye.Yu. Epidural analgesia and fever at labor. General Reanimatology. 2008; 4(5): 55. (in Russian)].https://dx.doi.org/10.15360/1813-9779-2008-5-55.
- Ren J., Wang T., Yang B., Jiang L., Xu L., Geng X., Liu Q. Risk factors and safety analyses for intrapartum fever in pregnant women receiving epidural analgesia during labor. Med. Sci. Monit. 2021; 27: e929283. https://dx.doi.org/10.12659/MSM.929283.
Received 07.02.2023
Accepted 29.08.2023
About the Authors
Nataliya M. Podzolkova, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia; Leading Researcher, S.P. Botkin City Clinical Hospital, Moscow Healthcare Department, +7(499)748-15-30, podzolkova@gmail.com,https://orcid.org/0000-0001-9183-7030, 105264, Russia, Moscow, Verkhnyaya Pervomaiskaya str., 57.
Yuliya V. Denisova, Clinical Resident, Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia, +7(499)748-15-30, yuliya.sheveleva.97@mail.ru, https://orcid.org/0000-0003-1753-0537, 105264, Russia, Moscow, Verkhnyaya Pervomaiskaya str., 57.
Andrey N. Gerasimov, Dr. Sci. (physical and mathematical sciences), Leading Researcher, Central Research Institute of Epidemiology, +7(495)788-00-01,
andr-gerasim@yandex.ru, https://orcid.org/0000-0003-4549-7172, 111123, Russia, Moscow, Novogireevskaya str., 3a.
Тatyana V. Denisova, PhD, Associate Professor, Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education,
Ministry of Health of Russia; obstetrician-gynecologist, F.I. Inozemtsev City Clinical Hospital, Moscow Healthcare Department, +7(499)748-15-30, sheveleva.net@mail.ru,
https://orcid.org/0000-0002-6549-107X, 105264, Russia, Moscow, Verkhnyaya Pervomaiskaya str., 57.
Corresponding author: Yuliya V. Denisova, yuliya.sheveleva.97@mail.ru
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