1
|
Lu R, Rong L, Ye L, Xu Y, Wu H. Effects of epidural analgesia on intrapartum maternal fever and maternal outcomes: an updated systematic review and meta-analysis. J Matern Fetal Neonatal Med 2024; 37:2357168. [PMID: 38812361 DOI: 10.1080/14767058.2024.2357168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Epidural-related maternal fever in women is a common clinical phenomenon that leads to adverse consequences for mothers and neonates. The meta-analysis aimed to quantify the risk for intrapartum maternal fever after epidural analgesia (EA) stratified according to parity. The secondary objective was to investigate the association between EA and maternal outcomes. METHODS An electronic literature search of the Medline/PubMed, Embase, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure databases was performed to identify studies reporting the occurrence of intrapartum fever in parturients. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and meta-analysis was performed using Review Manager version 5.3. RESULTS Seventeen randomized controlled trials (RCTs) (5959 parturients) were included. Odds ratios for maternal fever in the analysis were 4.17 (95% confidence interval (CI) 2.93-5.94) and 5.83 (95% CI 4.96-6.87), respectively. Results of subgroup analysis according to parity were consistent. EA significantly prolonged the length of the first stage of labor (MD 34.52 [95% CI 12.13-56.91]) and the second stage of labor (MD 9.10 [95% CI 4.51-13.68]). Parturients who received EA were more likely to undergo instrumental delivery (OR 2.03 [95% CI 1.44-2.86]) and oxytocin augmentation (OR 1.45 [95% CI 1.12-1.88]). There were no differences in cesarean delivery rates between the EA and non-EA groups. CONCLUSIONS Parturients who received EA exhibited a higher incidence of intrapartum fever. Credibility of the subgroup analyses was low because the mixed group did not effectively represent multiparas.
Collapse
Affiliation(s)
- Rui Lu
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Lijuan Rong
- Institute for Hospital Management, Tsinghua University, Shenzhen, China
| | - Li Ye
- Institute for Hospital Management, Tsinghua University, Shenzhen, China
| | - Ying Xu
- Institute for Hospital Management, Tsinghua University, Shenzhen, China
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Hao Wu
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| |
Collapse
|
2
|
Zhao B, Li B, Wang Q, Song X, Jia J. Cooling treatment on the reduction of category II fetal tracings. J Matern Fetal Neonatal Med 2024; 37:2299567. [PMID: 38199819 DOI: 10.1080/14767058.2023.2299567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES Epidural-related maternal fever increases the incidence of Category II fetal tracings. To compare the effectiveness of low-flow oxygen inhalation and cooling treatment for parturients with Category II fetal tracings caused by epidural-related maternal fever. METHODS We investigated 200 pregnant women who accepted epidural analgesia during labor and had body temperature exceeding 38 °C during labor. Among the patients, 99 and 101 were randomly allocated to receive cooling treatment group (control group) and oxygen inhalation (oxygen group), respectively. The primary outcome was the incidence of Category II fetal heart rate tracings. RESULTS The incidence of Category II fetal heart rate tracings in the control group was significantly higher than that in the oxygen group. However, no significant differences were noted between the two groups in terms of the Apgar scores; amniotic fluid turbidity; or maternal outcomes, including cesarean section rate, forceps delivery rate, lateral resection rate, manual removal of placenta rate, the amount of intrapartum hemorrhage, and hemorrhage at postpartum 2 h. Oxygen inhalation therapy was more effective than cooling treatment in reducing the incidence of Category II tracings. CONCLUSION Low-flow and short-term oxygen inhalation for parturients with epidural-related maternal fever reduces the incidence of Category II fetal heart rate tracings, but had no significant influence on the mode of delivery or neonatal outcomes.
Collapse
Affiliation(s)
- Baisong Zhao
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Bing Li
- Department of Anesthesiology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Qingning Wang
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xingrong Song
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Junxiang Jia
- Department of Anesthesiology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| |
Collapse
|
3
|
Winkler AE, Chou JH, West E, Bleiler C, Bell J, Gilbert J, Duzyj CM, Roumiantsev S, Lerou PH, Aurora M. Prevention of NICU Admission Hypothermia in Moderate- and Late-Preterm Infants. Pediatrics 2024; 154:e2023065117. [PMID: 39169849 DOI: 10.1542/peds.2023-065117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 06/05/2024] [Accepted: 06/12/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Neonatal hypothermia is a common and preventable cause of neonatal morbidity and mortality. Although hypothermia prevention has been extensively studied in infants <32 weeks' gestation, the authors of few studies have targeted moderate- and late-preterm infants (MLPIs) in the delivery room. METHODS This quality improvement initiative was conducted from June 2019 to June 2023 at the Massachusetts General Hospital NICU and Labor and Delivery Unit. All inborn MLPIs 32 + 0/7 to 36 + 6/7 weeks' gestation admitted to the NICU were included. We expanded thermoregulatory measures typically used in protocols for infants <32 weeks' gestation, including increasing delivery room ambient temperature to 74°F and thermal mattress use. The primary outcome was hypothermia (<36.5°C) after NICU admission. The balancing measure was hyperthermia (≥38 °C). RESULTS During the study period, there were 566 inborn MLPIs with a mean gestational age of 34 + 3/7 weeks and a mean birth weight of 2269 g. Special cause variation in neonatal hypothermia incidence was observed with a decrease from a mean baseline of 27% to 7.8% postintervention. Special cause variation was observed in hyperthermia incidence, with an increase from 1.4% to 6.2% postintervention largely initially associated with noncompliance with the protocol for thermal mattress removal. CONCLUSIONS The expansion of several thermoregulation techniques commonly used in infants <32 weeks' gestation, particularly thermal mattress use, was associated with a decreased incidence of NICU admission hypothermia in MLPIs, with an increase in mild hyperthermia predominantly associated with concomitant polyethylene wrap use.
Collapse
Affiliation(s)
- Amanda E Winkler
- Harvard Neonatal-Perinatal Medicine Fellowship Program, Boston, Massachusetts
- Division of Newborn Medicine, Department of Pediatrics
| | - Joseph H Chou
- Division of Newborn Medicine, Department of Pediatrics
| | - Elizabeth West
- Department of Obstetrics, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Janet Bell
- Division of Newborn Medicine, Department of Pediatrics
| | | | - Christina M Duzyj
- Department of Obstetrics, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Paul H Lerou
- Division of Newborn Medicine, Department of Pediatrics
| | - Megan Aurora
- Division of Newborn Medicine, Department of Pediatrics
| |
Collapse
|
4
|
Li K, Deng C, Sun D, Wang Y, Li G, Jiang L, Wang T. Predictive value of neutrophil-to-lymphocyte ratio on admission for intrapartum maternal fever in parturients undergoing epidural analgesia: A retrospective cohort study using propensity score-matched analysis. Int J Gynaecol Obstet 2024. [PMID: 39092575 DOI: 10.1002/ijgo.15820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/30/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To identify the predictive value of the neutrophil-to-lymphocyte ratio (NLR) on admission for intrapartum maternal fever in parturients undergoing epidural analgesia (EA). METHODS In this retrospective cohort study, propensity score matching (PSM) was applied to address covariates. Univariate and multivariate regression analyses were implemented in sequence to find out the factors influencing intrapartum fever. The receiver operating characteristics curve was applied to determine the area under the curve (AUC) of NLR for intrapartum fever. RESULTS NLR and duration of EA were independent risk factors for intrapartum fever. The AUC of the combined indicator (NLR + duration of EA) was higher than that of NLR (AUC = 0.583, 95% confidence interval [CI] 0.53-0.64) and duration of EA (AUC = 0.702, 95% CI 0.66-0.75), reaching 0.715 (95% CI 0.67-0.76; p < 0.001). NLR increased predictive performance for intrapartum fever when added to the duration of EA (net reclassification index 0.076, p = 0.022; integrated discrimination improvement 0.020, p = 0.002). CONCLUSION NLR has limited predictive power for intrapartum fever. The combination of NLR and duration of epidural analgesia may be considered a promising predictor for intrapartum maternal fever in parturients undergoing epidural analgesia. SYNOPSIS The neutrophil-to-lymphocyte ratio is an accessible predictor for the early identification of parturients at risk of intrapartum fever.
Collapse
Affiliation(s)
- Kunyue Li
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Chunyun Deng
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Daqi Sun
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yuxia Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Genxia Li
- Department of Obstetrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lihua Jiang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Tao Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
5
|
Kearns RJ, Broom MA, Lucas DN. Long-term effects of neuraxial analgesia. Curr Opin Anaesthesiol 2024; 37:227-233. [PMID: 38390906 DOI: 10.1097/aco.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW This review article explores the potential longer-term implications of neuraxial analgesia in labour for both the mother and her child. RECENT FINDINGS Neuraxial techniques for labour analgesia are well tolerated and effective, and long-term adverse sequelae are rare. Labour epidural analgesia is not independently associated with long-term headache, backache, postnatal depression or anal sphincter injury, and evidence supports that epidurals may offer protection against severe maternal morbidity, particularly in women at a higher risk of complications. However, there is an increasing awareness that postdural puncture headache may be associated with chronic headache, back pain and postnatal depression, emphasizing the need for adequate follow-up until symptoms resolve.For the neonate, a growing body of evidence refutes any association between epidural analgesia in labour and the later development of autism spectrum disorder. The clinical significance of epidural related maternal fever remains uncertain and is a research priority. SUMMARY Women should continue to access the significant benefits of neuraxial analgesia in labour without undue concern about adverse sequelae for themselves or their offspring. Measures to prevent, appropriately manage and adequately follow-up women who have suffered complications of neuraxial analgesia, such as postdural puncture headache, are good practice and can mitigate the development of long-term sequelae.
Collapse
Affiliation(s)
- Rachel J Kearns
- Princess Royal Maternity Unit
- School of Medicine, University of Glasgow, Glasgow
| | - Malcolm A Broom
- Princess Royal Maternity Unit
- School of Medicine, University of Glasgow, Glasgow
| | | |
Collapse
|
6
|
Jung E, Romero R, Suksai M, Gotsch F, Chaemsaithong P, Erez O, Conde-Agudelo A, Gomez-Lopez N, Berry SM, Meyyazhagan A, Yoon BH. Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment. Am J Obstet Gynecol 2024; 230:S807-S840. [PMID: 38233317 PMCID: PMC11288098 DOI: 10.1016/j.ajog.2023.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 04/05/2023]
Abstract
Clinical chorioamnionitis, the most common infection-related diagnosis in labor and delivery units, is an antecedent of puerperal infection and neonatal sepsis. The condition is suspected when intrapartum fever is associated with two other maternal and fetal signs of local or systemic inflammation (eg, maternal tachycardia, uterine tenderness, maternal leukocytosis, malodorous vaginal discharge or amniotic fluid, and fetal tachycardia). Clinical chorioamnionitis is a syndrome caused by intraamniotic infection, sterile intraamniotic inflammation (inflammation without bacteria), or systemic maternal inflammation induced by epidural analgesia. In cases of uncertainty, a definitive diagnosis can be made by analyzing amniotic fluid with methods to detect bacteria (Gram stain, culture, or microbial nucleic acid) and inflammation (white blood cell count, glucose concentration, interleukin-6, interleukin-8, matrix metalloproteinase-8). The most common microorganisms are Ureaplasma species, and polymicrobial infections occur in 70% of cases. The fetal attack rate is low, and the rate of positive neonatal blood cultures ranges between 0.2% and 4%. Intrapartum antibiotic administration is the standard treatment to reduce neonatal sepsis. Treatment with ampicillin and gentamicin have been recommended by professional societies, although other antibiotic regimens, eg, cephalosporins, have been used. Given the importance of Ureaplasma species as a cause of intraamniotic infection, consideration needs to be given to the administration of antimicrobial agents effective against these microorganisms such as azithromycin or clarithromycin. We have used the combination of ceftriaxone, clarithromycin, and metronidazole, which has been shown to eradicate intraamniotic infection with microbiologic studies. Routine testing of neonates born to affected mothers for genital mycoplasmas could improve the detection of neonatal sepsis. Clinical chorioamnionitis is associated with decreased uterine activity, failure to progress in labor, and postpartum hemorrhage; however, clinical chorioamnionitis by itself is not an indication for cesarean delivery. Oxytocin is often administered for labor augmentation, and it is prudent to have uterotonic agents at hand to manage postpartum hemorrhage. Infants born to mothers with clinical chorioamnionitis near term are at risk for early-onset neonatal sepsis and for long-term disability such as cerebral palsy. A frontier is the noninvasive assessment of amniotic fluid to diagnose intraamniotic inflammation with a transcervical amniotic fluid collector and a rapid bedside test for IL-8 for patients with ruptured membranes. This approach promises to improve diagnostic accuracy and to provide a basis for antimicrobial administration.
Collapse
Affiliation(s)
- Eunjung Jung
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
| | - Manaphat Suksai
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Francesca Gotsch
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Piya Chaemsaithong
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Obstetrics and Gynecology, Mahidol University, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand
| | - Offer Erez
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Agustin Conde-Agudelo
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Nardhy Gomez-Lopez
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI
| | - Stanley M Berry
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Arun Meyyazhagan
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Centre of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Bo Hyun Yoon
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
7
|
Chang G, Moiteiro Manteigas H, Strutton PH, Mullington CJ. An evaluation of a healthy participant laboratory model of epidural hyperthermia: a physiological study. Int J Obstet Anesth 2024; 57:103961. [PMID: 38199895 DOI: 10.1016/j.ijoa.2023.103961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 11/01/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Hyperthermia complicates 21% of cases of intrapartum epidural analgesia, but the mechanism is unclear. One hypothesis is that blockade of cholinergic sympathetic nerves prevents active vasodilation and sweating, thus limiting heat loss. Because labour increases heat production, this could create a situation in which heat production exceeds loss, causing body temperature to rise. This physiological study tested a novel laboratory model of epidural-related hyperthermia, using exercise to simulate the increased heat production of labour and surface insulation to simulate the effect of epidural analgesia. METHODS Twelve healthy non-pregnant participants (six female) cycled an ergometer for two hours at 20 Watts (W) on two occasions: once with surface insulation (intervention) and once without (control). Core temperature, skin temperature (eight sites), and heat loss (eight sites) were recorded. Mean body temperature and heat production were calculated. Values are mean (SD). RESULTS Exercise increased heat production on both visits (intervention 38 (18) W; control 37 (31) W; P = 0.94). Total heat loss was less on the intervention visit (intervention 115 (19) W; control 129 (23) W; P = 0.002). Core temperature increased on both visits (intervention 0.21 (0.37)°C; control 0.19 (0.27)°C; P < 0.001). The increase in mean body temperature was greater on the intervention visit (intervention 0.47 (0.41)°C; control 0.25 (0.19)°C; P = 0.007). CONCLUSIONS This laboratory model predicts that labour epidural analgesia limits heat loss by >14 W. Once the model is validated, it could be used to test the efficacy of potential interventions to prevent and treat epidural-related maternal hyperthermia.
Collapse
Affiliation(s)
- G Chang
- MSk Lab, Imperial College London, London, UK
| | - H Moiteiro Manteigas
- MSk Lab, Imperial College London, London, UK; Theatres and Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | | | - C J Mullington
- MSk Lab, Imperial College London, London, UK; Theatres and Anaesthetics, Imperial College Healthcare NHS Trust, London, UK.
| |
Collapse
|
8
|
Hu X, Wang B, Chen J, Han D, Wu J. Association Between Epidural Labor Analgesia and Autism Spectrum Disorder in Offspring: A Systematic Review and Meta-Analysis. J Pain Res 2024; 17:227-240. [PMID: 38230204 PMCID: PMC10790590 DOI: 10.2147/jpr.s442298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/21/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose Many studies have focused on the association between Autism spectrum disorder (ASD) and epidural labor analgesia (ELA), which is the most effective way to manage labor pain. The purpose of this meta-analysis was to summarize the current state of the association between ELA and ASD. Methods A search of the literature yielded 201 relevant studies, of which 7 cohort studies met our inclusion criteria. Two independent reviewers screened the inclusion results, extracted data, and assessed the risk of bias and quality of evidence. Results Compared to parturient who did not receive ELA, parturient who received ELA had a slightly increased risk of ASD (adjusted hazard ratio [aHR], 1.12; 95% confidence interval [CI], 1.06-1.17; I2, 69%; P < 0.001; seven studies). After excluding one literature (aHR, 1.09; 95% CI, 1.06-1.12; I2, 4%; P < 0.001; six studies). The sensitivity analyses had consistent outcomes with the main analyses involving siblings (aHR 1.11; 95% CI 1.03-1.19), cesarean section and instrumental deliveries (aHR 1.07; 95% CI 1.03-1.10), non-overlapping populations (aHR 1.09; 95% CI 1.05-1.12), full-term birth populations (aHR 1.10; 95% CI 1.06-1.14), and studies assessed to have moderate risk of bias (aHR 1.09; 95% CI 1.02-1.16). Conclusion This meta-analysis revealed a modest positive association between ELA and ASD, acknowledging a slight potential risk. However, it is important to note that this risk cannot be completely dismissed due to the possibility of bias and this association is based on low-quality evidence. Future studies are required to assess and mitigate different confounding biases and investigate the time-dose-response relationship.
Collapse
Affiliation(s)
- Xinyue Hu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, People’s Republic of China
| | - Beibei Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, People’s Republic of China
| | - Jing Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, People’s Republic of China
| | - Dong Han
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, People’s Republic of China
| | - Jing Wu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China
- Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Ministry of Education, Wuhan, People’s Republic of China
| |
Collapse
|
9
|
Cheng W, Xiong C, Li H, Wen J, Peng J, Wu S, Pan H, Chen L, Xia W, Zhao Y. Effects of early- and late- neuraxial analgesia on multiparous women: a retrospective monocentric study. BMC Anesthesiol 2024; 24:8. [PMID: 38166749 PMCID: PMC10759443 DOI: 10.1186/s12871-023-02395-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The mechanism underlying maternal fever and prolonged labor progression associated with neuraxial analgesia (NA) remains elusive, raising concerns among certain pregnant women regarding the application of NA during vaginal delivery. This study aimed to investigate the impact of early and late NA on maternal and neonatal outcomes in multiparous women. METHODS This retrospective study collected data from 1119 multiparous women with singleton pregnancies, full term and live births at our labor and delivery center between August 1st, 2021 and July 31st, 2022. Based on the timing of NA initiation, participants were categorized into three groups: no-NA, early-NA and late-NA. The no-NA group comprised of 172 women who did not receive NA during vaginal delivery; the early-NA group included 603 women in which NA was initiated when cervical dilation was between 0.5 and 2.0 cm; and the late-NA group comprising 344 cases in which NA was initiated at the cervical dilation of ≥ 2 cm. Maternal and neonatal outcomes were observed, including durations of the first, second, third and total stage of labor, the rate of intrapartum cesarean delivery (CD), intrapartum fever, postpartum hemorrhage (PPH), transfer to intensive care unit (ICU), admission to the neonatal intensive care unit (NICU), meconium-stained amniotic fluid, and neonatal Apgar scores at 1 and 5 min. RESULTS No differences were noted in the maternal age, body mass index (BMI) on admission, gestations, parity, gestational weeks at delivery and neonatal birth weight, or the rate of gestational diabetes mellitus (GDM) and hypertension disorder did not significantly differ among the three groups (p > 0.05). The no-NA group had shorter durations of first stage, second stage of labor compared to the early-NA or late-NA group (median, 215.0 min and 10.0 min vs. 300.0 min and 12.0 min vs. 280.0 min and 13.0 min) (p < 0.05), but no differences were observed between the early-NA and late-NA group (p > 0.05). There were no differences in the rate of intrapartum CD, intrapartum fever, PPH, maternal transferred to ICU, neonatal transfer to NICU, meconium-stained amniotic fluid, and postpartum stay ≥ 7d, as well as the neonatal the Apgar scores at 1 and 5 min among the three groups (p > 0.05). CONCLUSION NA is associated with extended durations of the first, second and total stages of labor. However, the early initiation of NA in multiparous women (cervical dilation within 0.5-2.0 cm) does not increase the risk of intrapartum CD or intrapartum fever. These findings endorse the secure utilization of early NA for pain relief during labor in multiparous women.
Collapse
Affiliation(s)
- Wenxing Cheng
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
- Wuhan University of Science and Technology, No. 2, Huangjiahu West Road, Hongshan District, Wuhan, 430065, China
| | - Chunyu Xiong
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Hao Li
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Jiao Wen
- Wuhan University of Science and Technology, No. 2, Huangjiahu West Road, Hongshan District, Wuhan, 430065, China
| | - Jing Peng
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Shiyao Wu
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Haotian Pan
- Department of Maternal and Child Health Hospital of Hubei Province, Hubei University of Medicine, Hubei University of Medicine, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Lei Chen
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China
| | - Weina Xia
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China.
| | - Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, No. 745, Wuluo Road, Hongshan District, Wuhan, 430070, China.
| |
Collapse
|
10
|
Chang XY, Wang LZ, Xia F, Zhang YF. Factors associated with epidural-related maternal fever in low-risk term women: a systematic review. Int J Obstet Anesth 2023; 56:103915. [PMID: 37625990 DOI: 10.1016/j.ijoa.2023.103915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/22/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The underlying mechanism of epidural-related maternal fever (ERMF) is not fully understood. This systematic review aimed to identify factors associated with ERMF in low-risk, full-term women using neuraxial analgesia. METHODS PubMed, Embase, Web of Science, CENTRAL, and Wanfang Data were searched from inception to September 10, 2022 with no language restriction. Studies reported descriptive data regarding the factors associated with ERMF. A random effects model meta-analysis was used to pool the raw data of univariate analyses for each identified factor. Sensitivity and subgroup analyses were performed to explore possible sources of heterogeneity. RESULTS Eighteen observational studies involving 33 427 women were included, with 18 factors eligible for meta-analyses. Higher body mass index, baseline temperature, admission maternal interleukin-6 levels and white blood cell counts, nulliparity, increasing gestational age, longer duration of labor and rupture of membranes, increasing number of vaginal examinations, oxytocin use, higher birth weight, lower cervical dilation at initiation of analgesia, and longer analgesia duration were associated with increased risk of ERMF, while intermittent compared with continuous epidural dosing was associated with a decreased risk of ERMF (odds ratio 0.25, 95% CI 0.16 to 0.48, P < 0.001). However, heterogeneity among studies was high and the quality of evidence was low for these meta-analyses, except for intermittent epidural dosing. CONCLUSIONS Many factors are associated with ERMF but may not be independent or causal. Further study is needed to clarify the interactions of these factors in ERMF development and whether modification of these factors might influence risk of ERMF.
Collapse
Affiliation(s)
- X Y Chang
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - L Z Wang
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital of Jiaxing University, Jiaxing, Zhejiang, China.
| | - F Xia
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Y F Zhang
- Department of Anesthesiology, Jiaxing Maternity and Children Health Care Hospital, Affiliated Women and Children Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| |
Collapse
|
11
|
Sultan P, Blumenfeld Y. Elucidating the effects of labor analgesia on fetal immune function and in utero temperature: a novel approach to understanding epidural-related maternal fever. Am J Obstet Gynecol 2023; 229:476-477. [PMID: 37120048 DOI: 10.1016/j.ajog.2023.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Pervez Sultan
- Department of Anesthesia, Critical Care and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305.
| | - Yair Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
12
|
Lawrence H, Morton A. Postpartum complications following neuraxial anaesthesia for obstetric physicians. Obstet Med 2023; 16:142-150. [PMID: 37720002 PMCID: PMC10504890 DOI: 10.1177/1753495x221146329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 12/04/2022] [Indexed: 09/19/2023] Open
Abstract
Neuraxial analgesia and anaesthesia are widely accepted and well-tolerated modes of delivery analgesia, being employed in up to 76% of vaginal deliveries and 94% of caesarean deliveries in the United States.1 A cause of considerable concern for postpartum women, their family and caring health professionals is the occurrence of unexplained postpartum complications, not only for management in the index pregnancy, but the uncertain risk of recurrence in future pregnancies. Complications of neuraxial blocks may impact significantly on the ability of mothers to care for and bond with their newborn. The reported incidence of temporary neurological deficit following obstetric neuraxial blocks is 1 in 3900 procedures, and the risk of permanent neurological harm estimated to be between 1 in 80,000 and 1 in 320,425 procedures.2 Obstetric physicians may be asked to review women with postpartum complications following neuraxial blocks. This article reviews complications that may be seen following neuraxial blocks for delivery.
Collapse
Affiliation(s)
- Heather Lawrence
- Obstetrics Department, Mater Health, Raymond Terrace, South Brisbane, Australia
| | - Adam Morton
- Obstetric Medicine, Mater Health, Raymond Terrace, South Brisbane, Australia
- Department of Medicine, University of Queensland, Herston, Australia
| |
Collapse
|
13
|
Zhang Z, Deng CM, Ma JH, Li S, Lei B, Ding T. Effects of neuraxial labor analgesia on intrapartum maternal fever in full-term pregnancy and its influence on birth outcomes. Front Med (Lausanne) 2023; 10:1208570. [PMID: 37534315 PMCID: PMC10390729 DOI: 10.3389/fmed.2023.1208570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction This study aimed to explore the relationship between neuraxial labor analgesia and intrapartum fever and to demonstrate the influence of maternal fever on perinatal outcomes within 6 weeks after birth. Methods This was a secondary analysis of a multicenter prospective cohort study that enrolled women with single- and full-term cephalic pregnancy in northern China. Intrapartum maternal fever was defined as the highest axillary temperature during labor ≥37.5°C. Data on baseline characteristics, maternal variables, and neonatal outcomes were all collected. The association between neuraxial labor analgesia and intrapartum maternal fever was analyzed with logistic regression models, and the cutoff point was identified by the receiver operating characteristic curve. Results Of 577 parturients, 74 (12.8%) developed intrapartum fever. Neuraxial analgesia was associated with an increased risk of maternal intrapartum fever with or without adjusting for confounding factors (adjusted OR = 2.68; 95% CI: 1.32-5.47; p = 0.007). Further analysis showed that neuraxial analgesia of <5 h did not increase the risk of intrapartum fever compared with no analgesia (OR = 1.52; 95% CI: 0.63-3.64; p = 0.35), and longer neuraxial labor analgesia time (over 5 h) significantly increased the risk of fever (OR = 3.38; 95% CI: 1.63-7.01; p = 0.001). Parturients with intrapartum fever suffered more maternal adverse outcomes compared with those without fever (p < 0.001). Neonates of women with intrapartum fever had slightly higher rates of composite adverse neonatal outcomes compared with those without fever; however, the difference was not statistically significant (p = 0.098). Conclusion In women with low-risk pregnancies, a longer time of neuraxial labor analgesia was associated with an increased risk of intrapartum maternal fever. Intrapartum fever was related to adverse maternal outcomes but did not significantly affect neonatal outcomes within 6 weeks after delivery.
Collapse
Affiliation(s)
- Zhen Zhang
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Chun-Mei Deng
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Jia-Hui Ma
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Shu Li
- Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Beijing, China
| | - Bo Lei
- Department of Anesthesiology, Haidian Maternal and Child Health Hospital, Beijing, China
| | - Ting Ding
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| |
Collapse
|
14
|
Zamstein O, Wainstock T, Sheiner E. Intrapartum Maternal Fever and Long-Term Infectious Morbidity of the Offspring. J Clin Med 2023; 12:jcm12093329. [PMID: 37176769 PMCID: PMC10179301 DOI: 10.3390/jcm12093329] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/29/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Maternal intrapartum fever can lead to various maternal and neonatal complications and is attributed to various etiologies including infectious and non-infectious processes. In this study, we evaluated whether intrapartum fever affects the offspring's tendency to long-term infectious morbidity. A population-based cohort analysis including deliveries between 1991 and 2021 was conducted. The incidence of hospitalizations of the offspring up to the age of 18 years, due to various infectious conditions, was compared between pregnancies complicated by intrapartum fever and those that were not. A Kaplan-Meier survival curve was used to assess cumulative hospitalization incidence. A Cox proportional hazards model was used to control for confounders. Overall, 538 of the 356,356 included pregnancies were complicated with fever. A higher rate of pediatric hospitalizations due to various infectious conditions was found among the exposed group, which was significant for viral, fungal and ENT infections (p < 0.05 for all). The total number of infectious-related hospitalizations was significantly higher (30.1% vs. 24.1%; OR = 1.36; p = 0.001), as was the cumulative incidence of hospitalizations. This association remained significant after controlling for confounders using a Cox proportional hazards model (adjusted HR = 1.21; 95% CI 1.04-1.41, p = 0.016). To conclude, fever diagnosed close to delivery may influence offspring susceptibility to pediatric infections.
Collapse
Affiliation(s)
- Omri Zamstein
- The Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel
| | - Tamar Wainstock
- The Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva POB 653, Israel
| | - Eyal Sheiner
- The Obstetrics and Gynecology Division, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel
| |
Collapse
|
15
|
Patel S, Ciechanowicz S, Blumenfeld YJ, Sultan P. Epidural-related maternal fever: incidence, pathophysiology, outcomes, and management. Am J Obstet Gynecol 2023; 228:S1283-S1304.e1. [PMID: 36925412 DOI: 10.1016/j.ajog.2022.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 03/18/2023]
Abstract
Epidural-related maternal fever affects 15% to 25% of patients who receive a labor epidural. Two meta-analyses demonstrated that epidural-related maternal fever is a clinical phenomenon, which is unlikely to be caused by selection bias. All commonly used neuraxial techniques, local anesthetics with or without opioids, and maintenance regimens are associated with epidural-related maternal fever, however, the impact of each component is unknown. Two major theories surrounding epidural-related maternal fever development have been proposed. First, labor epidural analgesia may lead to the development of hyperthermia through a sterile (noninfectious) inflammatory process. This process may involve reduced activation of caspase-1 (a protease involved in cell apoptosis and activation of proinflammatory pathways) secondary to bupivacaine, which impairs the release of the antipyrogenic cytokine, interleukin-1-receptor antagonist, from circulating leucocytes. Detailed mechanistic processes of epidural-related maternal fever remain to be determined. Second, thermoregulatory mechanisms secondary to neuraxial blockade have been proposed, which may also contribute to epidural-related maternal fever development. Currently, there is no prophylactic strategy that can safely prevent epidural-related maternal fever from occurring nor can it easily be distinguished clinically from other causes of intrapartum fever, such as chorioamnionitis. Because intrapartum fever (of any etiology) is associated with adverse outcomes for both the mother and baby, it is important that all parturients who develop intrapartum fever are investigated and treated appropriately, irrespective of labor epidural utilization. Institution of treatment with appropriate antimicrobial therapy is recommended if an infectious cause of fever is suspected. There is currently insufficient evidence to warrant a change in recommendations regarding provision of labor epidural analgesia and the benefits of good quality labor analgesia must continue to be reiterated to expectant mothers.
Collapse
Affiliation(s)
- Selina Patel
- Department of Anesthesia, Pain and Perioperative Medicine, University of Miami, Miller School of Medicine, Miami, FL
| | - Sarah Ciechanowicz
- Department of Anaesthesia, University College London Hospital, London, United Kingdom
| | - Yair J Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Pervez Sultan
- Department of Anesthesia, Critical Care and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
| |
Collapse
|
16
|
Neuraxial analgesia in labour and the fetus. Best Pract Res Clin Anaesthesiol 2023. [DOI: 10.1016/j.bpa.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
|
17
|
Chersich MF, Scorgie F, Filippi V, Luchters S. Increasing global temperatures threaten gains in maternal and newborn health in Africa: A review of impacts and an adaptation framework. Int J Gynaecol Obstet 2023; 160:421-429. [PMID: 35906840 PMCID: PMC10087975 DOI: 10.1002/ijgo.14381] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/26/2022] [Indexed: 01/20/2023]
Abstract
Anatomical, physiologic, and socio-cultural changes during pregnancy and childbirth increase vulnerability of women and newborns to high ambient temperatures. Extreme heat can overwhelm thermoregulatory mechanisms in pregnant women, especially during labor, cause dehydration and endocrine dysfunction, and compromise placental function. Clinical sequelae include hypertensive disorders, gestational diabetes, preterm birth, and stillbirth. High ambient temperatures increase rates of infections, and affect health worker performance and healthcare seeking. Rising temperatures with climate change and limited resources heighten concerns. We propose an adaptation framework containing four prongs. First, behavioral changes such as reducing workloads during pregnancy and using low-cost water sprays. Second, health system interventions encompassing Early Warning Systems centered around existing community-based outreach; heat-health indicator tracking; water supplementation and monitoring for heat-related conditions during labor. Building modifications, passive and active cooling systems, and nature-based solutions can reduce temperatures in facilities. Lastly, structural interventions and climate financing are critical. The overall package of interventions, ideally selected following cost-effectiveness and thermal modeling trade-offs, needs to be co-designed and co-delivered with affected communities, and take advantage of existing maternal and child health platforms. Robust-applied research will set the stage for programs across Africa that target pregnant women. Adequate research and climate financing are now urgent.
Collapse
Affiliation(s)
- Matthew F Chersich
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fiona Scorgie
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronique Filippi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Stanley Luchters
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
| | | |
Collapse
|
18
|
Baron EL, Katz D. Hot Off the Press! Commentary on “Maternal Fever Associated With Continuous Spinal Versus Epidural Labor Analgesia: A Single-Center Retrospective Study”. Anesth Analg 2022; 135:1151-1152. [DOI: 10.1213/ane.0000000000006063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
19
|
Seiler FA, Scavone BM, Shahul S, Arnolds DE. Maternal Fever Associated With Continuous Spinal Versus Epidural Labor Analgesia: A Single-Center Retrospective Study. Anesth Analg 2022; 135:1153-1158. [PMID: 35051951 DOI: 10.1213/ane.0000000000005905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Neuraxial labor analgesia is associated with elevations in maternal temperature; the mechanism responsible is unknown. Proposed mechanisms have included infection, altered thermoregulation, and inflammation, potentially triggered by local anesthetics. Studies of the association between neuraxial labor analgesia and maternal fever have focused on epidural analgesia, and there have been no comparisons of the rate of maternal fever between continuous spinal and epidural labor analgesia. METHODS We performed a retrospective study to compare the rate of maternal fever between patients who received continuous spinal versus epidural labor analgesia between June 2012 and March 2020. Each patient who received continuous spinal analgesia was matched to 2 patients who received epidural analgesia and had the same nulliparous status. The primary outcome of our study was the incidence of intrapartum maternal fever, which we defined as any temperature ≥38 °C before delivery and compared between the continuous spinal and epidural groups using Fisher exact test. RESULTS We identified 81 patients who received continuous spinal analgesia and 162 matched controls who received epidural analgesia. Demographic and obstetric characteristics of the patients were similar between groups. While the duration of analgesia did not significantly differ, there was markedly increased bupivacaine consumption in women with epidural analgesia. Eight of 81 (9.9%; 95% confidence interval [CI], 5.1-18.3) women with continuous spinal analgesia developed an intrapartum fever compared to 18 of 162 (11.1%; 95% CI, 7.1-16.9) of women with epidural analgesia ( P = .83; Fisher exact test). CONCLUSIONS There was no significant difference in the rate of maternal fever between women with continuous spinal compared to epidural labor analgesia. While the route of administration and dose of bupivacaine differs between epidural and spinal labor analgesia, they are titrated to produce similar levels of neuraxial blockade. Our results are consistent with a model in which epidural related maternal fever is due to altered thermoregulation from a central neuraxial block and argue against a direct effect of bupivacaine or fentanyl, although we cannot rule out a concentration-independent effect of bupivacaine or fentanyl or an inflammatory effect of the catheter itself. These retrospective results highlight the importance of prospective and mechanistic study of neuraxial analgesia-related maternal fever.
Collapse
Affiliation(s)
| | - Barbara M Scavone
- From the Departments of Anesthesia and Critical Care.,Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Sajid Shahul
- From the Departments of Anesthesia and Critical Care
| | | |
Collapse
|
20
|
Guasch E, Brogly N, Gilsanz F. Clinical practice and organizational standards in obstetric analgesia and anesthesia (EUROMISTOBAN): A European document. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:449-453. [PMID: 36085143 DOI: 10.1016/j.redare.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/17/2021] [Indexed: 06/15/2023]
Affiliation(s)
- E Guasch
- Servicio de Anestesia-Reanimación, Hospital Universitario La Paz, Madrid, Spain.
| | - N Brogly
- Servicio de Anestesia-Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - F Gilsanz
- Departamento de Cirugía, Facultad de Medicina, Universidad Autónoma de Madrid, Honorary Member ESAIC, Madrid, Spain
| |
Collapse
|
21
|
Zeng Y, Jiang T, Zheng YH, He WR, Wang XW, Wei H, Wang L, Liu ZR, Zhang XF, Yi C, Chen KM. Evaluation efficacy and safety of epidural analgesia in second-trimester induced labor: A single-center, prospective, non-randomized, controlled study. Medicine (Baltimore) 2022; 101:e30767. [PMID: 36197253 PMCID: PMC9509083 DOI: 10.1097/md.0000000000030767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Second-trimester induced labor in pregnant women was often more likely to suffer from psychological and physiological double pain. However, the analgesic management received less attention, and the optimal analgesic mode for second-trimester induced labor had not been determined. Our objective was to evaluate the feasible of epidural analgesia (EA) in second-trimester induced labor. METHODS From January 2020 to December 2021, Primipara who planned to undergo second-trimester induced labor in the First Affiliated Hospital of Yangtze University were collected. The method of labor induction was oral mifepristone + amniotic cavity injection of Ethacridine Lactate. Based on whether or not patients received epidural analgesia, which were divided into EA group (30 cases) and non-EA (NEA) group (30 cases). The primary outcome were visual analog scale (VAS) score of pain and result of follow-up, the secondary outcomes included relative clinical parameter and labor duration. RESULTS Vaginal induction of labor was successful in both groups. There was no statistically significant difference in VAS of pain between the two groups before analgesia (P > .05), but the VAS of pain in the EA group was significantly lower than the NEA group (P < .05) after analgesia or at delivery. The following outcomes showed no statistical difference between two groups: labor duration, postpartum hemorrhage, hemorrhage ≥ 500 mL, intrapartum injury, second days hemoglobin, C-reactive protein, antibiotic therapy days, hospitalizations days, and placenta residue (P > .05). The median hospitalization costs of EA group was 4697.5 yuan, and NEA group was 3673 yuan, the difference was statistically significant (P < .001). No adverse events related to EA occurred during hospitalization, only 3 patients showed mild lumbago and back pain after follow-up to three months postpartum, which was significantly relieved after proper rest. CONCLUSION EA can significantly reduce the pain of parturients, which may be effective and safe in the second-trimester induced labor.
Collapse
Affiliation(s)
- Yong Zeng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Tao Jiang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Ya-Hong Zheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Wen-Rong He
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Xiao-Wen Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Hua Wei
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Li Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Zu-Rong Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Xu-Feng Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Cunjian Yi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
| | - Ke-Ming Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Yangtze University, Jingzhou City, China
- *Correspondence: Ke-Ming Chen, 8 Hangkong Road, Shashi District, Jingzhou City, Hubei Province 434000, China (e-mail:)
| |
Collapse
|
22
|
Interventions for the prevention or treatment of epidural-related maternal fever: a systematic review and meta-analysis. Br J Anaesth 2022; 129:567-580. [PMID: 35934529 PMCID: PMC9575042 DOI: 10.1016/j.bja.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/18/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022] Open
Abstract
Background Epidural-related maternal fever in women in labour has consequences for the mother and neonate. There has been no systematic review of preventive strategies. Methods RCTs evaluating methods of preventing or treating epidural-related maternal fever in women in active labour were eligible. We searched MEDLINE, EMBASE, CINAHL, Web of Science, CENTRAL, and grey literature sources were searched from inception to April 2021. Two review authors independently undertook study selection. Data extraction and quality assessment was performed by a single author and checked by a second. The Cochrane Risk of Bias 2 tool was used. Meta-analyses for the primary outcome, incidence of intrapartum fever, were performed using the DerSimonian and Laird random effects model to produce summary risk ratios (RRs) with 95% confidence intervals (95% CIs). Results Forty-two records, representing 34 studies, were included. Methods of reduced dose epidural reduced the incidence of intrapartum fever, but this was not statistically significant when six trials at high risk of bias were removed (seven trials; 857 participants; RR=0.83; 95% CI, 0.41–1.67). Alternative methods of analgesia and high-dose prophylactic systemic steroids reduced the risk of intrapartum fever compared with epidural analgesia. Prophylactic paracetamol was not effective. Conclusions There is no clear evidence to support the use of any individual preventative or therapeutic intervention for epidural-related maternal fever. Further research should focus on understanding the mechanism of fever development to enable RCTs of potential interventions to reduce the incidence of intrapartum fever development and the subsequent disease burden felt by the neonate. Clinical trial registration CRD42021246929.
Collapse
|
23
|
Deng CM, Ding T, Liu ZH, He ST, Ma JH, Xu MJ, Wang L, Li M, Liang WL, Li XY, Ma D, Wang DX. Impact of maternal neuraxial labor analgesia exposure on offspring's neurodevelopment: A longitudinal prospective cohort study with propensity score matching. Front Public Health 2022; 10:831538. [PMID: 35968440 PMCID: PMC9373030 DOI: 10.3389/fpubh.2022.831538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/12/2022] [Indexed: 02/01/2023] Open
Abstract
Background Neuraxial analgesia is widely used to relieve labor pain; its effects on long-term neurodevelopment of offspring remain unclear. This study was designed to investigate the influence of maternal neuraxial labor analgesia on offspring mental development. Methods This was a predefined secondary analysis of a 2-year prospective longitudinal study. Nulliparous women with single-term cephalic pregnancy preparing for vaginal delivery self-selected neuraxial analgesia or not during labor. Mothers and their offspring were followed up 2 years later. children's mental development was assessed with the bayley scales of infant development. A multivariable logistic model was used to identify factors associated with below-average mental development (Mental Development Index <90). Results A Total of 508 pairs of mothers and children completed a 2-year follow-up. after propensity score matching, 387 pairs were included in the analysis. In both cohorts, the proportions with below-average mental development were slightly lower in children whose mothers received neuraxial labor analgesia, although not statistically significant [in the full cohort: 9.8 % (36/368) vs. 15.7% (22/140), P = 0.060; In the matched cohort: 8.3% (21/254) vs. 14.3% (19/133), P = 0.065]. A higher 2-year depression score (in the full cohort: Odds Ratio 1.15, 95% CI 1.08–1.22, P < 0.001; In the matched cohort: Odds Ratio 1.09, 95% CI 1.01–1.18, P = 0.037), but not neuraxial analgesia exposure, was associated with an increased risk of below-average mental development. Conclusions Maternal depression at 2 years was associated with the risk of below-average mental development, whereas maternal exposure to neuraxial labor analgesia was not. Clinical Trial Registration The study was registered with www.chictr.org.cn (ChiCTR-OCH-14004888) and ClinicalTrials.gov (NCT02823418).
Collapse
Affiliation(s)
- Chun-Mei Deng
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Ting Ding
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Zhi-Hua Liu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Shu-Ting He
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Jia-Hui Ma
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Ming-Jun Xu
- Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Beijing, China
| | - Lei Wang
- Department of Anesthesiology, Haidian Maternal & Child Health Hospital, Beijing, China
| | - Ming Li
- Department of Pediatrics, Peking University First Hospital, Xicheng District, Beijing, China
| | - Wei-Lan Liang
- Department of Pediatrics, Peking University First Hospital, Xicheng District, Beijing, China
| | - Xue-Ying Li
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Daqing Ma
- Section of Anesthetics, Pain Management and Intensive Care, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
- Outcomes Research Consortium, Cleveland, OH, United States
- *Correspondence: Dong-Xin Wang ;
| |
Collapse
|
24
|
Halliday L, Nelson SM, Kearns RJ. Epidural analgesia in labor: A narrative review. Int J Gynaecol Obstet 2022; 159:356-364. [PMID: 35277971 DOI: 10.1002/ijgo.14175] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 11/11/2022]
Abstract
Lumbar epidural is the most effective form of pain relief in labor with around 30% of laboring women in the UK and 60% in the USA receiving epidural analgesia. Associations of epidural on maternal, obstetric, and neonatal outcomes have been the subject of intense study, though a number of uncertainties persist. The present narrative review explores important areas of research surrounding epidural analgesia in obstetric patients including methods of initiation and administration, choice of local anesthetic solution, and the addition of adjuvants. Key meta-analyses exploring associations of epidural analgesia on maternal and neonatal outcomes are identified and summarized.
Collapse
Affiliation(s)
- Lucy Halliday
- School of Medicine, University of Glasgow, Glasgow, UK
| | | | | |
Collapse
|
25
|
Butwick AJ, Abrams DA, Wong CA. Epidural labour analgesia and autism spectrum disorder: is the current evidence sufficient to dismiss an association? Br J Anaesth 2022; 128:393-398. [PMID: 35039173 PMCID: PMC10941096 DOI: 10.1016/j.bja.2021.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/02/2022] Open
Abstract
Findings from a population-based study using a sibling-matched analysis published in this issue of the British Journal of Anaesthesia indicate that epidural labour analgesia is not associated with an increased risk of autism spectrum disorder. These findings are consistent with those from three other population-based studies that used similar methodological approaches. Cumulatively, these robust, high-quality epidemiological data support the assertion that there is no meaningful association between epidural labour analgesia and autism spectrum disorder in offspring.
Collapse
Affiliation(s)
- Alexander J Butwick
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Daniel A Abrams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Cynthia A Wong
- Department of Anesthesia, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
26
|
Jack JM, Ellicott HE, Thorburn PT, Chakladar A, Harper CM. Accurate core temperature measurement during Caesarean delivery. Comment on Br J Anaesth 2021; 126: 500-15. Br J Anaesth 2021; 127:e210-e211. [PMID: 34688472 DOI: 10.1016/j.bja.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- J M Jack
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
| | - H E Ellicott
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - P T Thorburn
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Chakladar
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - C M Harper
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| |
Collapse
|
27
|
Mori Y, Toyama S, Sato M, Yamashita Y, Suzuki Y, Sago H. Influence of preterm labour epidural analgesia on neonatal and maternal outcomes: a single-centre retrospective study. Br J Anaesth 2021; 127:e154-e156. [PMID: 34420683 DOI: 10.1016/j.bja.2021.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/05/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Yumiko Mori
- Department of Anesthesiology, Otsu City Hospital, Shiga, Japan
| | - Satoshi Toyama
- Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences, Tokyo, Japan; Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan.
| | - Masaki Sato
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Yoko Yamashita
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Yasuyuki Suzuki
- Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
28
|
Barger MK. Current Resources for Evidence-Based Practice, May/June 2021. J Midwifery Womens Health 2021; 66:413-421. [PMID: 34166576 DOI: 10.1111/jmwh.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
| |
Collapse
|