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Chorioamnionitis, not epidural analgesia, is associated with maternal fever during labour

[La chorio-amnionite est associée à la fièvre puerpérale pendant le travail, mais non l'analgésie épidurale]

Manuel C. Vallejo, MD^*, Bupesh Kaul, MD^*, Lauri J. Adler, MD^*, Amy L. Phelps, PhD, Catherine M. Craven, MD, Trevor A. Macpherson, MD, Richard L. Sweet, MD and Sivam Ramanathan, MD^*

^* From the Departments of Anesthesiology,
Pathology,
Obstetrics and Gynecology, Magee-Womens Hospital, University of Pittsburgh School of Medicine, and
Quantitative Sciences (School of Business), Duquense University, Pittsburgh, Pennsylvania, USA.

Dr. Manuel C. Vallejo, Department of Anesthesiology, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Phone: 412-641-4260; Fax: 412-641-4766; E-mail: vallejomc{at}anes.upmc.edu

Purpose: Maternal fever is associated with chorioamnionitis and has been linked to labour epidural analgesia (LEA). The purpose of this study was to determine possible associations between LEA and chorioamnionitis, maternal fever, operative delivery rate, and neonatal outcome.

Methods: Data from 14,073 patients were entered into a database over a two-year period. From this database, 62 nulliparous parturients with clinical chorioamnionitis (amnionitis), but without LEA were identified (Group I). Two other groups who received LEA were matched for parity and gestation: Group II – LEA with concomitant amnionitis (n=50) and, Group III – LEA without concomitant amnionitis (n=201). The diagnosis of chorioamnionitis was confirmed by histologic examination. Results are expressed as mean ± SD and analyzed at P <0.05 using ANOVA or Chi-square.

Results: No differences were noted among the groups in the operative delivery rate or Apgar scores at five minutes. The percentage of patients with maternal fever during labour (38.0°C) with amnionitis was significantly less in Group III compared to the other groups (100% in both Groups I and II vs 1.0% in Group III; P=0.000). Likewise, Group III had a lower percentage of neonates with Apgar scores <7 at one minute (35.5% in Group I, 20.0% in Group II, 17.4% in Group III; P=0.010). The percentage of histologic chorioamnionitis was significantly higher in both amnionitis groups compared to Group III (67.7% in Group I, 56.0% in Group II, 4.0% in Group III; P=0.000).

Conclusion: LEA without chorioamnionitis is not associated with maternal fever (38.0°C), increased operative delivery rates or low Apgar scores.

This article has been cited by other articles:

				Y. Cohen, M. C. Vallejo, B. Kaul, and S. Ramanathan Epidural analgesia and maternal fever Can J Anesth, August 1, 2002; 49(7): 760 - 760. [Full Text]