Retrospective analysis of hyperthermia associated with epidural analgesia and its relationship with labor progression and delivery mode
- Authors: Podzolkova N.M.1,2, Denisova Y.V.1, Gerasimov A.N.3, Denisova Т.V.1,4
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Affiliations:
- Russian Medical Academy for Continuing Professional Education, Ministry of Health of the Russian Federation
- S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
- Central Research Institute for Epidemiology
- F.I. Inozemtsev City Clinical Hospital, Moscow Healthcare Department
- Issue: No 9 (2023)
- Pages: 129-138
- Section: Discussion Article
- URL: https://journals.eco-vector.com/0300-9092/article/view/622971
- DOI: https://doi.org/10.18565/aig.2023.32
- ID: 622971
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Abstract
Objective: To investigate the association between hyperthermia during labor and the use of epidural analgesia (EA), identify the risk factors for its occurrence, and analyze the impact of EA on labor progression and delivery methods.
Materials and methods: This study included 1874 delivery records from January 1 to June 31, 2021, at D.D. Pletnev City Clinical Hospital in Moscow. Among these, 956 involved EA, whereas 918 did not use neuraxial anesthesia. The study categorized cases based on temperature elevation (temperature ≥37°C and <37.5°C, indicative of hyperthermia tendency; temperature ≥37.5°C, hyperthermia) and delivery type (vaginal delivery (VD) and cesarean section (CS)). Patients who gave birth with EA and a temperature <37.5°C (877/956) constituted subgroup A, whereas those with a temperature ≥37.5°C (79/956) belonged to subgroup B. A comparative analysis of patient history, one-way correlation analysis, and analysis of variance were conducted to identify factors predisposing patients to hyperthermia.
Results: The analysis revealed a statistically significant association between the use of EA for pain relief during labor and the occurrence of hyperthermia. Specifically, 97.53% (79/81) of hyperthermia cases were recorded in patients who received EA (95% CI:93.31–99.23, p<0.001). Predisposing factors included the duration of labor, interval between anesthetic administration, number of vaginal examinations (all p<0.001), amniotic fluid characteristics (p=0.001), and cervical dilation at the time of analgesia (p=0.002). Hyperthermia in the presence of EA was associated with a higher risk of operative delivery, with emergency CS performed 2.5 times more frequently (30.4% (24/79) vs. 12.2% (107/877), p<0.001) and vacuum-assisted fetal extraction performed 2.9 times more frequently (10.1% (8/79) vs. 3.5% (31/877), p=0.003) in subgroup B than in subgroup A. The most common indication for surgery was fetal distress, (patients with EA and a body temperature of 37.5°C or higher were 2.6 times more likely to have fetal distress than in those without hyperthermia (29.1% (23/79) and 11.4% (100/877), p <0.001).
Conclusion: Early and prolonged EA is associated with an increased risk of hyperthermia, operative delivery, and adverse perinatal outcomes. Optimizing the application of this form of labor pain relief can enhance the quality of obstetric care.
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About the authors
Nataliya M. Podzolkova
Russian Medical Academy for Continuing Professional Education, Ministry of Health of the Russian Federation; S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
Email: podzolkova@gmail.com
ORCID iD: 0000-0001-9183-7030
Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia; Leading Researcher, S.P. Botkin City Clinical Hospital, Moscow Healthcare Department
Russian Federation, Moscow; MoscowYuliya V. Denisova
Russian Medical Academy for Continuing Professional Education, Ministry of Health of the Russian Federation
Author for correspondence.
Email: yuliya.sheveleva.97@mail.ru
ORCID iD: 0000-0003-1753-0537
Clinical Resident, Department of Obstetrics and Gynecology
Russian Federation, MoscowAndrey N. Gerasimov
Central Research Institute for Epidemiology
Email: andr-gerasim@yandex.ru
ORCID iD: 0000-0003-4549-7172
Dr. Sci. (physical and mathematical sciences), Leading Researcher
Russian Federation, MoscowТatyana V. Denisova
Russian Medical Academy for Continuing Professional Education, Ministry of Health of the Russian Federation; F.I. Inozemtsev City Clinical Hospital, Moscow Healthcare Department
Email: sheveleva.net@mail.ru
ORCID iD: 0000-0002-6549-107X
PhD, Associate Professor, Department of Obstetrics and Gynecology, Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia; obstetrician-gynecologist, F.I. Inozemtsev City Clinical Hospital, Moscow Healthcare Department
Russian Federation, Moscow; MoscowReferences
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