Does Maternal Fever During Labor Analgesia Has Any Relationship With Maternal Ventilation?
Condition: Pregnancy
Study type: Observational

Summary: 
      Epidural techniques offer the advantage of being able to titrate the level, density, and
      duration of the blockade through the use of a catheter and are associated with relative
      maternal hemodynamic stability. One of the disadvantages, however, include a raise in
      maternal temperature that is attributed to labor epidural technique. This study will assess
      if decreased maternal ventilation following induction of labor analgesia causes a raise in
      temperature.
    

Detailed description: 
      Fever in labor complicates up to one-third of deliveries. The etiologies of intrapartum fever
      are diverse and include maternal chorioamnionitis, and other infections. In addition,
      epidural analgesia used for pain relief in labor is associated with mild maternal temperature
      increase and overt fever. Originally dismissed by obstetric anesthesiologists as a clinical
      curiosity of little consequence, epidural-associated hyperthermia may lead to significant
      maternal as well as fetal or neonatal adverse effects. Observational investigations performed
      2 decades ago demonstrated a gradual increase in temperature in laboring parturients with
      epidural analgesia not see in those electing systemic opioid analgesia or no analgesia. The
      epidural group showed an average increase in temperature of approximately 1 degree centigrade
      over 7 hours whereas temperatures in non-epidural group remained constant. No evidence of
      clinical infection was reported in any of the women. Many studies confirmed these raises in
      temperature in epidural group compared to no epidural group during labor and delivery.

      Several mechanisms have been postulated with no study reaching a conclusion. The mechanisms
      suggested include imbalance between heat production and heat dissipation, effect of opioid on
      interleukin-2, markers of inflammation induced by epidural analgesia, etc. Our study aims at
      the first mechanism. It may be a physiological process that leads to an imbalance between
      heat production and heat dissipation. Labor is a hyper metabolic state and increased heat
      production is dissipated via increased ventilation that is associated with labor pains with
      no epidural pain relief. It is conceivable that laboring women with pain relief subsequent to
      epidural analgesia, a decrease in ventilations may occur leading to decreased heat
      dissipation.
    

Intervention name(s): Labor analgesia
Intervention type(s): Other
Intervention description(s): Measuring maternal ventilation after placement of epidural analgesia compared to baseline
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Informed consent will be obtained by one of the licensed physician investigators at the
        earliest opportunity when the subject arrives on the labor suite and following contact with
        their provider. While the timing between subject arrival and request for neuraxial
        analgesia can be variable, in subjects who present in early labor at less than 5 cm cervial
        dilation, there is often several hours available for a subject to consider 1) whether they
        desire a central neuraxial technique during labor, and 2) whether they would be willing to
        participate in this study.