epidurals: Weighing the Risks - SciAm

[Guest guest]

I would suggest that the last sentence - the seizures are

more-than-likely from the hep b vax at birth - of course they didn't even

mention that other variable

Sheri

Weighing the Risks - SciAm

Women who opt for epidurals are more likely to run a fever during

labor that can endanger their babyBy Melinda Wenner Moyer

| April 24, 2012

http://www.scientificamerican.com/article.cfm?id=weighing-the-risks

....mothers have new findings to factor into their decisions. In a study

published in February in the journal Pediatrics, researchers at the

Harvard School of Public Health and Harvard Medical School followed 3,209

women with low-risk pregnancies who were giving birth to their first

child. Of those receiving epidurals, nearly one out of five developed a

fever of at least 100.4 degrees Fahrenheit during labor compared with

only 2.4 percent of those receiving other drugs or no pain relief. The

higher the mother’s fever, the more likely the baby was to have low Apgar

scores after birth—an indicator of overall newborn health—as well as low

mus­cle tone and breathing difficulties. And the 8.6 percent of women

receiving epidurals who developed a fever of greater than 101 degrees F

were more than six times as likely as non­febrile moms to have babies who

had new­born seizures, although the overall seizure risk was only 1.3

percent...

- - - -

Intrapartum

temperature elevation, epidural use, and adverse outcome in term

infants.

Greenwell EA, Wyshak G, Ringer SA, LC, Rivkin MJ, Lieberman

E.

Pediatrics. 2012 Feb;129(2):e447-54. Epub 2012 Jan 30.

OBJECTIVES: To examine the association of intrapartum temperature

elevation with adverse neonatal outcome among low-risk women receiving

epidural analgesia and evaluate the association of epidural with adverse

neonatal outcome without temperature elevation.

METHODS: We studied all low-risk nulliparous women with singleton

pregnancies 37 weeks delivering at our hospital during 2000, excluding

pregnancies where infants had documented sepsis, meningitis, or a major

congenital anomaly. Neonatal outcomes were compared between women

receiving (n = 1538) and not receiving epidural analgesia (n = 363) in

the absence of intrapartum temperature elevation ( 99.5°F) and according

to the level of intrapartum temperature elevation within the group

receiving epidural (n = 2784). Logistic regression was used to evaluate

neonatal outcome while controlling for confounders.

RESULTS: Maternal temperature >100.4°F developed during labor in 19.2%

(535/2784) of women receiving epidural compared with 2.4% (10/425) not

receiving epidural. In the absence of intrapartum temperature elevation (

99.5°F), no significant differences were observed in adverse neonatal

outcomes between women receiving and not receiving epidural. Among women

receiving epidural, a significant linear trend was observed between

maximum maternal temperature and all neonatal outcomes examined including

hypotonia, assisted ventilation, 1- and 5-min Apgar scores <7, and

early-onset seizures. In regression analyses, infants born to women with

fever >101°F had a two- to sixfold increased risk of all adverse

outcomes examined.

CONCLUSIONS: The proportion of infants experiencing adverse outcomes

increased with the degree of epidural-related maternal temperature

elevation. Epidural use without temperature elevation was not associated

with any of the adverse outcomes we studied.

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