Re: epidurals: Weighing the Risks - SciAm

[Guest guest]

One needs  to look at the whole study beyond the abstract  to see the factors

they ccontrolled for.Women who had epidurals may have had longer, harder labprs,

more pain, an other factors. Even though they started labor " low risk " they may

not be the same population who gets by without epidurals. Also the really

healthy women may choose naturzl labor than the less healthy ones even though

they are both technically " low risk. " This seems true to me for pregnant women

that I work with.

There is an entity such as an epidural fever without infection.

But maybe we are talking about low garde choriamnionitis (infection) rather than

epidural fever that is more linled to the difficulty of labor OR immune system

issues rather than just placement of an epidural.

M Davenport MD FACOG

Subject: epidurals: Weighing the Risks - SciAm

To:

Date: Saturday, April 21, 2012, 7:00 AM

      Weighing the Risks

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

        during labor that can endanger their baby

By 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. <http://www.ncbi.nlm.nih.gov/pubmed/22291120>

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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