Maternal fever, neonatal sepsis evaluation, and epidural labor analgesia

Background and Objectives: Numerous studies have found an association between epidural analgesia for labor and maternal fever (temperature greater than or equal to 38 degrees C). Maternal fever often results in treatment with maternal or neonatal antibiotics, neonatal sepsis evaluation, and increased costs. Methods: Medline was used to identify literature regarding the association between epidural labor analgesia and maternal fever/neonatal sepsis. Studies examining thermoregulation during pregnancy and/or epidural analgesia were also reviewed. Results: There appears to be a strong association between epidural labor analgesia and maternal fever. The link between epidural labor analgesia and neonatal sepsis evaluation is less clear. The incidence of confirmed neonatal sepsis does not increase with maternal epidural analgesia. Causes of the association between epidural labor analgesia and maternal fever include selection bias, altered thermoregulation, and increased shivering or decreased sweating with epidural analgesia. Conclusions: Maternal epidural labor analgesia is associated with maternal fever and possibly increased neonatal sepsis evaluation There is no proof the relationship is causal.