Epidural Plus Fever in Mom May Raise Risks for
FRIDAY. Feb. 3 (HealthDay News) -- The babies of women who
develop an epidural-related fever while in labor are at greater
risk of having problems right at birth, including poor muscle tone,
breathing difficulties, low Apgar scores and seizures, a new study
The Apgar score is a test used to measure a child's skin color,
pulse and overall vigor in the moments after birth.
Prior research has found an association between epidurals -- or
anesthesia delivered into the epidural space around the spinal cord
-- and fevers in some moms during labor.
This study, which involved more than 3,200 women delivering a
full-term baby at Brigham and Women's Hospital in Boston in 2000,
found a similar association.
Just over 19 percent of those who had an epidural developed a
temperature of greater than 100.4 degrees F compared with just 2.4
percent of women who went without the painkiller.
The higher a woman's temperature, the more likely the baby was
to experience problems.
For example, about 11 percent of babies whose mothers that a
normal or only slightly elevated temperature at birth had low
muscle tone lasting less than 15 minutes at birth, compared with
about 25 percent of babies with moms who had a fever above 101
About 4.4 percent of babies with moms whose temperatures were
normal needed resuscitation measures at delivery, ranging from
breathing assistance to chest compressions, compared with more than
12 percent of babies whose mothers had a fever of over 101
Only eight babies in the study experienced seizures, but babies
whose moms had a fever of 101 degrees or greater were more likely
to be among them, according to the study.
Researchers took into account other factors that could affect
the baby's health at birth, such as gestational diabetes in the
mother or a known infection in the mother or the baby.
For women who didn't develop a fever, researchers found no
differences in outcomes for babies for women who had an epidural
vs. those who didn't.
"It's clear that from our data that about 20 percent of the term infants born to mothers who received epidurals experienced one or more adverse outcomes after birth," said study author Elizabeth Greenwell, a doctoral candidate at Harvard School of Public Health when she did the research.
The study is published in the February issue of
More than 60 percent of the 4 million women who give birth each
year in the United States get epidurals, according to background
information in the study. In some hospitals, the number is much
higher than that. In the group of women who delivered in Boston,
for example, 87 percent had epidurals.
In this group of women receiving epidurals, 8.6 percent
developed a fever of higher than 101 degrees; 10.7 percent had a
temperature of 100.5 to 101 degrees; and 25.5 percent had a
temperature of 99.6 degrees to 100.4 degrees.
Those who developed fevers tended to be older, and have larger
babies and longer labors.
The reasons for the link between epidural and fever aren't well
understood, but it's believed that inflammatory processes are
involved, Greenwell said.
Most epidural-related fevers emerge after the woman has been
numb for six hours or more, Greenwell noted, so one option for
women who are worried about it might want to delay getting the
epidural for as long as they can, she said.
Dr. Eva Pressman, a maternal-fetal medicine specialist at
University of Rochester Medical Center, said "epidural fevers"
However, in this study, researchers didn't do enough to rule out
another cause for the fever, intrauterine infection. Those
infections can come on quickly during labor and can be very serious
for the baby, including causing brain damage, Pressman said. Known
as chorioamnionitis, intrauterine infections are caused by bacteria
from the vagina, that, as the cervix opens, inflames the fetal
"Chorioamnionitis has been strongly associated with adverse neonatal outcomes, especially cerebral palsy," Pressman said.
To confirm that fevers were due to the epidural and not an
infection, researchers would have had to examine the placenta after
birth, she said.
What's also not reported is if the women received IV antibiotics
to treat an infection, or acetaminophen to treat fever, and if that
would have improved how the child did, Pressman said.
"You can't tell if the adverse outcome was related to the epidural or an underlying infection that was inadequately treated," she said. "But it does reinforce that fever in labor is marker for some sort of inflammatory processes, but whether that inflammatory process is related to an epidural or an underlying infectious process, this study doesn't tell us."
Nemours has more on epidurals.
Copyright © 2012
. All rights reserved.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.