Epidural analgesia during labor and maternal fever

Background: In recent observational studies, epidural analgesia during labo r at patient request has been associated with maternal fever. The authors r eport a secondary analysis of fever in women who were randomized to receive either epidural or patient-controlled intravenous analgesia during labor. Methods: Maternal tympanic temperature was measured during spontaneous labo r in 715 women at term who mere randomized to either epidural analgesia wit h bupivacaine and fentanyl or to patient-controlled intravenous analgesia w ith meperidine, Intent-to-treat analysis of women with fever (temperature g reater than or equal to 38.0 degrees C) versus those without was performed using Student t test and Fisher exact test to determine statistical signifi cance (P < 0.05). Results: Epidural analgesia was associated with maternal fever (odds ratio = 4.0; 95% confidence Interval = 2.0-7.7), as was nulliparity (odds ratio = 4.1; 95% confidence interval = 1.8-9.1) and labor longer than 12 h (odds r atio = 5.4; 95% confidence interval = 2.9-9.9). These factors were all inde pendent variables for maternal fever when analyzed using logistic regressio n. Conclusions: Epidural analgesia is associated with maternal fever. However, nulliparity and dysfunctional labor are also significant cofactors in the fever attributed to epidural analgesia.