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Keywords:

  • epidural;
  • fetal position;
  • fever;
  • intrapartum temperature;
  • labor;
  • occiput posterior

Introduction: To evaluate the relationship between maternal temperature elevation and occiput posterior position at birth as well as the association of fetal head position and temperature elevation on method of birth among women receiving epidural analgesia.

Methods: We conducted a secondary analysis of data from the Fetal Orientation during Childbirth by Ultrasound Study (FOCUS), which used serial ultrasounds to evaluate the effect of epidural anesthesia on fetal position at birth in low-risk women. The current analysis was limited to the 1428 study participants who received epidural analgesia.

Results: In our population, 47% (n = 669) of women had a maximum intrapartum temperature greater than or equal to 99.6°F (37.6°C). The prevalence of fetal occiput posterior position at admission did not differ between women who later developed temperature elevations (24.4%) and those who did not (23.6%, P= .70). Women who developed an elevated temperature greater than or equal to 99.6°F (37.6°C) had an increased risk of occiput posterior fetal head position at birth regardless of the amount of temperature elevation (odds ratio [OR]= 2.0; 95% confidence interval [CI], 1.5-2.8); the association persisted after control for potentially confounding factors (adjusted OR = 1.5; 95% CI, 1.1-2.1). The cesarean birth rate among women with both temperature elevation and occiput posterior position at birth was more than 12 times the rate of women with neither risk factor (adjusted OR = 12.6; 95% CI, 7.5-21.2).

Discussion: Intrapartum temperature elevation among women receiving epidural analgesia, even if only to 99.6°F (37.6°C), is associated with approximately a 2-fold increase in the occurrence of occiput posterior fetal head position at birth. Additionally, although this observational study cannot establish causal links, our findings suggest that the relationship between epidural-related intrapartum temperature elevation and occiput posterior position at birth could contribute to an increased cesarean birth rate among women receiving epidural analgesia for pain relief in labor.