The Effects of Combined Spinal Epidurals on Fever During Labor of First-Time Mothers
The Effects of Combined Spinal Epidurals on Fever During Labor of First-Time Mothers
The purpose of this study is to determine if the epidural of local anesthetics has an effect
 on fever that may occur in first time mothers during labor.
Intrapartum fever (fever during labor) is a real and potentially devastating problem. Infants
 delivered at term who have been exposed to the mother having a fever during labor have a >9
 fold increased risk of cerebral palsy. Studies have also shown an increased risk of neonatal
 encephalopathy associated with fever during labor. Maternal fever in the absence of infection
 is associated with a 4 fold increased risk of neonatal hypoxic encephalopathy and 3.4 fold
 increased risk of unexplained neonatal seizures.

 The likely role of inflammatory mediators in the process of maternal fever (temperature
 >100.4), regardless of etiology, makes it important to further investigational studies in an
 effort to discover the etiology of intrapartum fever associated with epidural analgesia. If
 an inflammatory trigger (i.e., the injection of epidural local anesthetics) can be identified
 or delayed, then the risks of maternal hyperthermia can be minimized and/ or eliminated.

 The greatest risk of fever with epidural labor analgesia is seen in women having their first
 child. This is the same population associated with prolonged labor. Although intrapartum
 fever has a very low incidence overall, 11-33% of first-time mothers will eventually develop
 fever >100.4 during epidural analgesia. Although the degree of rise in temperature occurs
 very slowly, it has been shown to be significant enough to cause increased neonatal sepsis
 workup and antibiotic coverage for both the mother and the neonate.
Inclusion Criteria:

 -  having first child (nulliparous)

 -  term pregnancy (> 37 weeks)

 -  vertex presentation

 -  singleton gestation

 -  ability to provide informed consent

 -  request for analgesia for labor pain

 Exclusion Criteria:

 -  birth of second or more child (multiparous)

 -  preterm pregnancy (< 37 weeks)

 -  presentation other than vertex (ie. breech, transverse)

 -  diabetic

 -  admit temperature > 99.5

 -  active drug/alcohol dependence

 -  active genital herpes infection

 -  allergy to anesthetics used