Pharmacological interventions for intrapartum fever in labor analgesia: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LI Mengzhou ¹ , LIU Yue ² ,  TANG Yuying ¹

1. Department of Anesthesiology, West China Second University Hospital, Chengdu 610041, P. R. China;
2. Department of Anesthesiology, Sichuan Taikang Hospital, Chengdu 610200, P. R. China;

Corresponding author：

TANG Yuying, Email: yuyingtang@scu.edu.cn

Keywords：

Labor analgesia; Intrapartum fever; Corticosteroids; Acetaminophen; Antibiotics; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.202311169

Video：

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Objective To systematically evaluate the clinical efficacy and safety of glucocorticoids, acetaminophen and antimicrobial drugs in the treatment of intrapartum fever in labor analgesia. Methods The PubMed, Embase, Cochrane Library, Web of Science, CBM, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of glucocorticoids, acetaminophen, and antimicrobial drugs for intrapartum fever in labor analgesia from inception to June 30, 2023. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included literature. Meta-analysis was then performed by using RevMan 5.4 software. Results A total of 10 RCTs involving 1 337 women were included. Meta-analysis showed that the use of glucocorticoids reduced the incidence of intrapartum fever in women with labor analgesia compared with the control group (OR=0.52, 95%CI 0.33 to 0.82, P=0.005). But there was no statistically significant difference between acetaminophen or antimicrobial drugs and the control group. Conclusion Current evidence shows that the use of glucocorticoids can reduce the incidence of intrapartum fever in labor analgesia, but the use of acetaminophen and antimicrobial drugs cannot reduce the incidence of intrapartum fever. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

1.	徐铭军, 姚尚龙. 中国分娩镇痛现状与对策. 国际麻醉学与复苏杂志, 2018, 39(4): 289-293,337.
2.	Jansen S, Lopriore E, Naaktgeboren C, et al. Epidural-related fever and maternal and neonatal morbidity: a systematic review and meta-analysis. Neonatology, 2020, 117(3): 259-270.
3.	Fusi L, Steer PJ, Maresh MJ, et al. Maternal pyrexia associated with the use of epidural analgesia in labour. Lancet, 1989, 1(8649): 1250-1252.
4.	Sultan P, David AL, Fernando R, et al. Inflammation and epidural-related maternal fever: proposed mechanisms. Anesth Analg, 2016, 122(5): 1546-1553.
5.	Sharpe EE, Arendt KW. Epidural labor analgesia and maternal fever. Clin Obstet Gynecol, 2017, 60(2): 365-374.
6.	Arendt KW, Segal BS. The association between epidural labor analgesia and maternal fever. Clin Perinatol, 2013, 40(3): 385-398.
7.	Ashwal E, Salman L, Tzur Y, et al. Intrapartum fever and the risk for perinatal complications - the effect of fever duration and positive cultures. J Matern Fetal Neonatal Med, 2018, 31(11): 1418-1425.
8.	Segal S. Labor epidural analgesia and maternal fever. Anesth Analg, 2010, 111(6): 1467-1475.
9.	Riley LE, Celi AC, Onderdonk AB, et al. Association of epidural-related fever and noninfectious inflammation in term labor. Obstet Gynecol, 2011, 117(3): 588-595.
10.	Goetzl L, Zighelboim I, Badell M, et al. Maternal corticosteroids to prevent intrauterine exposure to hyperthermia and inflammation: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol, 2006, 195(4): 1031-1037.
11.	Wang LZ, Hu XX, Liu X, et al. Influence of epidural dexamethasone on maternal temperature and serum cytokine concentration after labor epidural analgesia. Int J Gynaecol Obstet, 2011, 113(1): 40-43.
12.	Dube P, Mitra S, Singh J, et al. Intravenous dexamethasone as an adjunct to improve labor analgesia: A randomized, double-blinded, placebo controlled clinical trial. J Clin Anesth, 2017, 43: 6-10.
13.	Dhal A, Mitra S, Saroa R, et al. Can epidural dexamethasone reduce patient-controlled epidural consumption of fentanyl and levobupivacaine in laboring women. A double-blind, randomized, placebo-controlled trial. J Obstet Gynaecol India, 2019, 69(3): 258-265.
14.	Goodier C, Newman R, Hebbar L, et al. Maternal epidural steroids to prevent neonatal exposure to hyperthermia and inflammation. Am J Perinatol, 2019, 36(8): 828-834.
15.	卢冬梅, 龙焱, 周龑, 等. 地塞米松对硬膜外分娩镇痛产妇发热的影响. 临床麻醉学杂志, 2021, 37(8): 828-831.
16.	Evron S, Ezri T, Protianov M, et al. The effects of remifentanil or acetaminophen with epidural ropivacaine on body temperature during labor. J Anesth, 2008, 22(2): 105-111.
17.	Goetzl L, Rivers J, Evans T, et al. Prophylactic acetaminophen does not prevent epidural fever in nulliparous women: a double-blind placebo-controlled trial. J Perinatol, 2004, 24(8): 471-475.
18.	Gupta K, Mitra S, Kazal S, et al. I. V. paracetamol as an adjunct to patient-controlled epidural analgesia with levobupivacaine and fentanyl in labour: a randomized controlled study. Br J Anaesth, 2016, 117(5): 617-622.
19.	Sharma SK, Rogers BB, Alexander JM, et al. A randomized trial of the effects of antibiotic prophylaxis on epidural-related fever in labor. Anesth Analg, 2014, 118(3): 604-610.
20.	Wohlrab P, Boehme S, Kaun C, et al. Ropivacaine activates multiple proapoptotic and inflammatory signaling pathways that might subsume to trigger epidural-related maternal fever. Anesth Analg, 2020, 130(2): 321-331.
21.	Cartledge A, Hind D, Bradburn M, et al. Interventions for the prevention or treatment of epidural-related maternal fever: a systematic review and meta-analysis. Br J Anaesth, 2022, 129(4): 567-580.

1. 徐铭军, 姚尚龙. 中国分娩镇痛现状与对策. 国际麻醉学与复苏杂志, 2018, 39(4): 289-293,337.
2. Jansen S, Lopriore E, Naaktgeboren C, et al. Epidural-related fever and maternal and neonatal morbidity: a systematic review and meta-analysis. Neonatology, 2020, 117(3): 259-270.
3. Fusi L, Steer PJ, Maresh MJ, et al. Maternal pyrexia associated with the use of epidural analgesia in labour. Lancet, 1989, 1(8649): 1250-1252.
4. Sultan P, David AL, Fernando R, et al. Inflammation and epidural-related maternal fever: proposed mechanisms. Anesth Analg, 2016, 122(5): 1546-1553.
5. Sharpe EE, Arendt KW. Epidural labor analgesia and maternal fever. Clin Obstet Gynecol, 2017, 60(2): 365-374.
6. Arendt KW, Segal BS. The association between epidural labor analgesia and maternal fever. Clin Perinatol, 2013, 40(3): 385-398.
7. Ashwal E, Salman L, Tzur Y, et al. Intrapartum fever and the risk for perinatal complications - the effect of fever duration and positive cultures. J Matern Fetal Neonatal Med, 2018, 31(11): 1418-1425.
8. Segal S. Labor epidural analgesia and maternal fever. Anesth Analg, 2010, 111(6): 1467-1475.
9. Riley LE, Celi AC, Onderdonk AB, et al. Association of epidural-related fever and noninfectious inflammation in term labor. Obstet Gynecol, 2011, 117(3): 588-595.
10. Goetzl L, Zighelboim I, Badell M, et al. Maternal corticosteroids to prevent intrauterine exposure to hyperthermia and inflammation: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol, 2006, 195(4): 1031-1037.
11. Wang LZ, Hu XX, Liu X, et al. Influence of epidural dexamethasone on maternal temperature and serum cytokine concentration after labor epidural analgesia. Int J Gynaecol Obstet, 2011, 113(1): 40-43.
12. Dube P, Mitra S, Singh J, et al. Intravenous dexamethasone as an adjunct to improve labor analgesia: A randomized, double-blinded, placebo controlled clinical trial. J Clin Anesth, 2017, 43: 6-10.
13. Dhal A, Mitra S, Saroa R, et al. Can epidural dexamethasone reduce patient-controlled epidural consumption of fentanyl and levobupivacaine in laboring women. A double-blind, randomized, placebo-controlled trial. J Obstet Gynaecol India, 2019, 69(3): 258-265.
14. Goodier C, Newman R, Hebbar L, et al. Maternal epidural steroids to prevent neonatal exposure to hyperthermia and inflammation. Am J Perinatol, 2019, 36(8): 828-834.
15. 卢冬梅, 龙焱, 周龑, 等. 地塞米松对硬膜外分娩镇痛产妇发热的影响. 临床麻醉学杂志, 2021, 37(8): 828-831.
16. Evron S, Ezri T, Protianov M, et al. The effects of remifentanil or acetaminophen with epidural ropivacaine on body temperature during labor. J Anesth, 2008, 22(2): 105-111.
17. Goetzl L, Rivers J, Evans T, et al. Prophylactic acetaminophen does not prevent epidural fever in nulliparous women: a double-blind placebo-controlled trial. J Perinatol, 2004, 24(8): 471-475.
18. Gupta K, Mitra S, Kazal S, et al. I. V. paracetamol as an adjunct to patient-controlled epidural analgesia with levobupivacaine and fentanyl in labour: a randomized controlled study. Br J Anaesth, 2016, 117(5): 617-622.
19. Sharma SK, Rogers BB, Alexander JM, et al. A randomized trial of the effects of antibiotic prophylaxis on epidural-related fever in labor. Anesth Analg, 2014, 118(3): 604-610.
20. Wohlrab P, Boehme S, Kaun C, et al. Ropivacaine activates multiple proapoptotic and inflammatory signaling pathways that might subsume to trigger epidural-related maternal fever. Anesth Analg, 2020, 130(2): 321-331.
21. Cartledge A, Hind D, Bradburn M, et al. Interventions for the prevention or treatment of epidural-related maternal fever: a systematic review and meta-analysis. Br J Anaesth, 2022, 129(4): 567-580.

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