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Intrapartum fever associated with epidural labor analgesia

2021.11.06 / Saturday
Intrapartum fever associated with epidural labor analgesia





First of all, we have to ask, what is ERMF?

The answer is, epidural-related Maternal Fever (ERMF)


The relationship between epidural analgesia in childbirth and the gradual increase in maternal temperature was first reported by a professor in 1989. Although epidural analgesia was initially questioned as a cause of the increase in body temperature of pregnant women, some observations were later. Both research and randomized controlled studies support this association.


Although there is a correlation between epidural labor analgesia and maternal fever, it cannot be confirmed that there is a direct or inevitable relationship between the two, and the exact mechanism is inconclusive.


The fever rate of women receiving epidural analgesia varies greatly, ranging from 11% to 33%, but the reason for this difference is not clear.

Due to the adverse effects of fever on the parturient and fetus, this complication has caused widespread concern among clinicians.



ERMF and body temperature regulation function


The maintenance of normal body temperature depends on the body's dynamic balance of heat production and heat dissipation.


Pain, uterine contraction, and skeletal muscle movement during normal childbirth all increase heat production; while sweating and hyperventilation help to dissipate heat, and the two coordinate and balance to maintain the body's normal body temperature.


Epidural labor analgesia may interfere with the response of the hypothalamic body thermoregulation center to cold and heat, and increase thermogenesis. After epidural anesthesia, the incidence of maternal chills is higher, leading to a further increase in heat production.

For parturients with analgesia during labor, hyperventilation is reduced due to pain relief, which reduces heat dissipation. In addition, epidural labor analgesia can block sympathetic nerves, which can cause blood vessels below the block level to dilate, while compensatory contraction of blood vessels above the block level and reduce heat dissipation.
In addition, studies have shown that epidural block can change the response to body temperature regulation by increasing the threshold of thermoregulatory sweating, thereby reducing heat dissipation. The combined effect of the above changes can lead to an imbalance between heat production and heat dissipation, with more heat production but less heat dissipation, thereby increasing the body temperature of the parturient.


For the safety of childbirth, it is recommended to use a disposable medical  temperature probe to monitor the maternal body temperature in real time during the entire delivery process, which is conducive to the timely adjustment of the delivery plan by the medical staff.