Perinatal outcomes and risk factors for epidural analgesia-associated intrapartum maternal fever: a retrospective study

Figures & data

Table 1. Characteristics of study population.

	Entire population		None-fever		ERMF		p Value
	n = 208		n = 166		n = 42
Maternal age (yr), No. (%)							.804
≤24	27	(12.98)	21	(12.65)	6	(14.29)
25–29	94	(45.19)	74	(44.58)	20	(47.62)
30–34	76	(36.54)	61	(36.75)	15	(35.71)
≥35	11	(5.29)	10	(6.02)	1	(2.38)
Height (cm), No. (%)							.851
≤154	14	(6.73)	11	(6.63)	3	(7.14)
155–164	136	(65.38)	108	(65.06)	28	(66.67)
165–174	55	(26.44)	44	(26.51)	11	(26.19)
≥175	3	(1.44)	3	(1.81)	0	(0.00)
BMI at delivery (kg/m^2), No. (%)^a							.285
≤24.9	64	(30.77)	47	(28.31)	17	(40.48)
25.0–29.9	125	(60.10)	104	(62.65)	21	(50.00)
≥30	19	(9.13)	15	(9.04)	4	(9.52)
Gravidity, No. (%)							.004
1	106	(50.96)	75	(45.18)	31	(73.81)
2	60	(28.85)	53	(31.93)	7	(16.67)
≥3	42	(20.19)	38	(22.89)	4	(9.52)
Parity, No. (%)							<.001
1	159	(76.44)	117	(70.48)	42	(100.00)
≥2	49	(23.56)	49	(29.52)	0	(0.00)
Pregnancy complications
GDM							.805
No	180	(86.54)	144	(86.75)	36	(85.71)
Yes	28	(13.46)	22	(13.25)	6	(14.29)
Gestational hypertensive disease							.603
No	202	(97.12)	160	(96.39)	42	(100.00)
Yes	6	(2.88)	6	(3.61)	0	(0.00)
Intrahepatic cholestasis of pregnancy, ICP							.488
No	194	(93.27)	156	(93.98)	38	(90.48)
Yes	14	(6.73)	10	(6.02)	4	(9.52)
Cephalopelvic disproportion, CPD							.057
No	203	(97.60)	164	(98.80)	39	(92.86)
Yes	5	(2.40)	2	(1.20)	3	(7.14)
Pregnancy anemia							.218
No	127	(61.06)	105	(63.25)	22	(52.38)
Yes	81	(38.94)	61	(36.75)	20	(47.62)

^aCalculated as weight in kilograms divided by height in meters squared.

Table 2. Baseline characteristics, maternal and neonatal outcomes of EA participants.

Characteristics	None-fever	ERMF	p Value
	n = 166	n = 42
Maternal age (yr)	28.95 ± 3.77	28.05 ± 3.68	0.898
Maternal height (cm)	161.95 ± 5.57	160.57 ± 5.14	0.149
Maternal BMI at delivery (kg/m^2)	26.51 ± 2.90	26.08 ± 2.72	0.39
Gestational weeks	39.62 ± 0.98	39.81 ± 0.82	0.248
WBC (×10^9/L)	8.71 ± 2.54	9.53 ± 2.91	0.07
N (×10^9/L)	6.47 ± 2.38	7.44 ± 2.82	0.024
N (%)	72.97 ± 7.09	74.73 ± 12.52	0.231
CRP (mg/L)	8.46 ± 7.45	9.81 ± 7.39	0.296
IL-6 (pg/mL)	14.04 ± 30.66	14.74 ± 29.47	0.895
Amount of medicine (mL)	43.87 ± 20.58	52.48 ± 24.17	0.021
Total EA duration (min)	383.42 ± 369.04	630.57 ± 484.12	0.000
Time of first stage (min)	344.84 ± 198.62	549.66 ± 248.20	0.000
Time between EA and onset of the fever (min)	–	338.95 ± 55.16	–
Time of second stage (min)	25.05 ± 21.64	33.38 ± 32.70	0.196
Time of third stage (min)	7.6 ± 7.83	9.38 ± 9.01	0.275
Total labor time (min)	377.72 ± 205.99	588.62 ± 257.43	0.000
Frequent cervical examinations (times)	5.98 ± 1.92	7.56 ± 1.96	0.000
Birth weight (g)	3406.20 ± 393.90	3301.67 ± 363.00	0.120
Apgar score (1 min)	9.55 ± 0.68	9.40 ± 0.63	0.200
Apgar score (5 min)	9.88 ± 0.35	9.81 ± 0.40	0.070
Volume of postpartum hemorrhage (mL)	399.29 ± 124.83	293.24 ± 78.41	0.024

Table 3. Association between ERMF and risks of adverse maternal and neonatal outcomes among women underwent EA.

	Entire population		None-fever			ERMF
	n	%	n	%	OR (95% CI)	n	%	OR (95% CI)	p Value	AOR (95% CI)	p Value
Total number	208		166			42
Postpartum hemorrhage	6	(2.88)	6	(3.61)	1.00 (ref)	0	(0.00)	/	0.603	/
Conversion to surgery	24	(11.54)	12	(7.23)	1.00 (ref)	12	(28.57)	5.13 (2.11, 12.51)	0.000	4.05 (1.44, 11.39)	0.008
Forceps delivery	8	(3.85)	6	(3.61)	1.00 (ref)	2	(4.76)	1.33 (0.26, 6.86)	0.664	1.81(0.28, 11.59)	0.531
Fetal distress	18	(8.65)	11	(6.63)	1.00 (ref)	7	(16.67)	2.82 (1.02, 7.79)	0.060	0.54 (0.18, 1.64)	0.276
Neonatal Infections	28	(13.46)	13	(7.83)	1.00 (ref)	15	(35.71)	6.54 (2.80, 15.27)	0.000	5.13 (1.98, 13.29)	0.001
NICU admission	12	(5.77)	11	(6.63)	1.00 (ref)	1	(2.38)	0.34 (0.04, 2.74)	0.466	0.38 (0.04, 3.30)	0.377

BMI: body mass index; OR: odds ratio; CI: confidence interval. Data are shown as OR and adjusted OR (95% CI), adjusted for maternal age, BMI at delivery, gestational weeks, gravidity, parity, GDM, gestational hypertensive disease, ICP, CPD, and pregnancy anemia.

Table 4. Risk factors for ERMF among women underwent labor EA.

	Total no.	n (%)		OR	p value	Adjusted OR (95% CI)	p Value
All women (n = 208)
Maternal pathogen infection
No	131	22	(16.79)	1.00 (ref)		1.00 (ref)
Yes	77	20	(25.97)	1.74 (0.88, 3.45)	.152	1.66 (0.80, 3.46)	.174
Rupture pattern of membranes
Natural	73	10	(13.70)	1.00 (ref)		1.00 (ref)
Atificial	135	32	(23.70)	1.96 (0.90, 4.25)	.090	1.54 (0.64, 3.71)	.335
Parity
1	159	42	(26.42)	1.00 (ref)	/	1.00 (ref)	/
≥2	49	0	(0.00)	–		–
Gravidy
1	106	31	(29.25)	1.00 (ref)		1.00 (ref)
2	60	7	(11.67)	0.32 (0.13, 0.78)	.012	0.30 (0.12, 0.76)	.011
≥3	42	4	(9.52)	0.26 (0.08, 0.77)	.016	0.27 (0.08, 0.91)	.035
Frequent cervical examinations
<5	34	2	(5.88)	1.00 (ref)		1.00 (ref)
5–6	97	12	(12.37)	2.26 (0.48,10.66)	.303	1.89 (0.39, 9.29)	.432
≥7	74	27	(36.49)	9.19 (2.04, 41.40)	.004	7.27 (1.56, 33.99)	.012
Missing	3	1	(33.33)	–		–
Time of first stage (min)
<168.8	22	2	(9.09)	1.00 (ref)		1.00 (ref)
168.8–259	44	3	(6.82)	0.73 (0.11, 4.74)	.743	0.82 (0.12, 5.79)	.840
260–442.4	58	5	(8.62)	0.94 (0.17,5.26)	.947	1.10 (0.18,6.68)	.916
≥442.5	58	19	(32.76)	4.87 (1.03, 23.04)	.046	6.62 (1.23, 35.50)	.027
Missing	26	13	(50.00)	–		–
Total labor time (min)
<200	24	2	(8.33)	1.00 (ref)		1.00 (ref)
200–284	42	3	(7.14)	0.85 (0.13, 5.46)	.861	0.93 (0.13, 6.51)	.861
285–489	57	6	(10.53)	1.29 (0.24,6.92)	.763	1.41 (0.25,8.07)	.763
≥490	59	18	(30.51)	4.83 (1.03, 22.75)	.046	5.85 (1.12, 30.49)	.036
Missing	27	13	(48.15)	–		–
Total EA duration (min)
<150.4	50	5	(10.00)	1.00 (ref)		1.00 (ref)
150.5–303.4	53	5	(9.43)	0.94 (0.25, 3.45)	.923	0.69 (0.17, 2.74)	.596
303.5–609.0	52	14	(26.92)	3.32 (1.09,10.04)	.034	2.75 (0.84,9.03)	.095
≥610.0	52	18	(34.62)	4.77 (1.61, 14.11)	.005	3.86 (1.20, 12.47)	.024
Missing	1	0	0		–		–
Amount of medicine (mL)
<30	44	4	(9.09)	1.00 (ref)		1.00 (ref)
31–39	54	10	(18.52)	2.27 (0.66, 7.82)	.193	2.02 (0.56, 7.26)	.193
40–55	57	13	(22.81)	2.96 (0.89, 9.80)	.077	2.56 (0.74, 8.83)	.136
≥56	52	15	(28.85)	4.05 (1.23, 13.32)	.021	2.85 (0.81, 10.08)	.104
Missing	1	0	0		–		–

OR: odds ratio; CI: confidence interval. Data are shown as OR and adjusted OR (95% CI), adjusted for maternal age, BMI at delivery, gestational weeks, GDM, gestational hypertensive disease, ICP, CPD, and pregnancy anemia.

Data availability statement

The datasets used and analyzed during the current study available from the corresponding author on reasonable request.