Effects of epidural labor analgesia-related intrapartum fever on maternal and neonatal outcomes

doi:10.3877/cma.j.issn.1673-5250.2022.05.012

Objective

To investigate the effect of epidural labor analgesia-related intrapartum fever (ELARIF) on maternal and neonatal outcomes.

Methods

A total of 980 parturients who underwent epidural labor analgesia (ELA) in Zhenjiang Maternity & Child Health Hospital from January 2019 to December 2020 were selected as research subjects. According to whether maternal ELARIF occurred or not, they were divided into fever group (n=74, parturients with ELARIF whose tympanic temperature ≥ 38 ℃), and control group (n=906, parturients without ELARIF whose tympanic temperature <38 ℃) by retrospective cohort study method. The general clinical data, intrapartum and postpartum related data, ELA related data and neonatal related data of two groups of parturients were compared by independent-samples t test, Mann-Whitney U test, chi-square test, continuity adjusted chi-square test or Fisher exact probability method. The procedure followed in this study met requirements of the Helsinki Declaration of the World Medical Association revised in 2013.

Results

①There were no significant differences between two groups in terms of age, height, gestational age at delivery, times of abortions, incidence of premature rupture of membranes, body mass index (BMI) before pregnant and at delivery, increased value of BMI during pregnancy, incidence of hypertension in pregnancy, gestational diabetes mellitus, upper respiratory tract infection, and group B streptococcal infection, white blood cell count, percentage of neutrophils and hemoglobin at delivery and other general clinical data (P>0.05). ②The total incidence of artificial rupture of membranes, incidence of artificial rupture of membranes caused by ELARIF, rate of conversion to cesarean section, duration of the first and second stages of labor and total stage of labor, the time from the beginning of labor to ELA, the time from ELA to delivery, and incidence of postpartum urinary retention (PUR) of spontaneous parturients in fever group all were significantly higher or longer than those in control group, and all the differences were statistically significant (P<0.05). ③In fever group, the dosage of ELA in parturients who were transferred to cesarean section was (39.9±24.2) mL, ELA duration was 4.8 h (3.8 h, 6.3 h), and score of pain Numerical Rating Scale (NRS) at the end of ELA was 6 points (5 points, 6 points), which were significantly higher and longer than (37.1±24.9) mL, 3.6 h (2.3 h, 5.3 h) and 4 points (3 points, 5 points) in control group respectively, and all differences were statistically significant (t=-8.18, Z=-4.22, Z=-8.48; P<0.001). ④The incidence of amniotic fluid fecal contamination, fetal distress, Apgar score <10 points at 5 min after birth, and transfer to Department of Neonatology due to infection in fever group were significantly higher than those in control group (P<0.05).

Conclusions

Delayed delivery can increase the risk of ELARIF, while ELARIF will lead to increased risk of intrapartum intervention and delivery. Clinicians should pay attention to the labor process management of ELA parturients. Once abnormalities are found, clinicians should timely take accurate and effective measures to promote the progress of labor process and reduce the incidence of adverse maternal and neonatal outcomes.

Key words: Analgesia, epidural, Analgesia, obstetrical, Fever, Labor pain, Pregnancy outcome, Cesarean section, Puerpera

表1 2组采取ELA产妇一般临床资料比较

组别	例数	年龄(岁，±s)	身高(cm, ±s)	分娩孕龄(周，±s)	流产次数[次，M(Q₁，Q₃)]	胎膜早破[例数(%)]	BMI(kg/m², ±s)
组别	例数	年龄(岁，±s)	身高(cm, ±s)	分娩孕龄(周，±s)	流产次数[次，M(Q₁，Q₃)]	胎膜早破[例数(%)]	孕前	分娩时	孕期增加值
发热组	74	27.4±2.9	161.6±4.4	39.8±1.0	0(0，0)	15(20.3)	21.4±2.8	27.5±2.9	6.1±2.1
对照组	906	26.8±3.2	162.5±4.8	39.6±1.0	0(0，0)	232(25.6)	20.9±2.8	26.9±3.2	5.9±2.2
统计量		t＝-1.67	t＝1.58	t＝-1.43	Z＝-0.74	χ²＝1.03	t＝-1.24	t＝-1.44	t＝-0.48
P值		0.096	0.114	0.153	0.462	0.309	0.216	0.149	0.631
组别	例数	妊娠合并症[例数(%)]		感染高危因素[例数(%)]		分娩入院时血常规(±s)
组别	例数	妊娠期高血压	妊娠期糖尿病	上呼吸道感染	B族链球菌感染	白细胞计数(×10⁹/L)	中性粒细胞百分比(%)	血红蛋白(g/L)
发热组	74	3(4.1)	16(21.6)	1(1.4)	0(0)	8.4±2.0	74.3±5.7	125.8±10.1
对照组	906	42(4.6)	124(13.7)	10(1.1)	16(1.8)	8.7±2.2	74.1±5.9	123.9±10.9
统计量		χ²<0.01^a	χ²＝3.52	—^b	χ²＝0.46^a	t＝1.37	t＝-0.23	t＝-1.46
P值		>0.999	0.061	0.380	0.499	0.171	0.816	0.144

表1 2组采取ELA产妇一般临床资料比较

组别	例数	年龄(岁，±s)	身高(cm, ±s)	分娩孕龄(周，±s)	流产次数[次，M(Q₁，Q₃)]	胎膜早破[例数(%)]	BMI(kg/m², ±s)
组别	例数	年龄(岁，±s)	身高(cm, ±s)	分娩孕龄(周，±s)	流产次数[次，M(Q₁，Q₃)]	胎膜早破[例数(%)]	孕前	分娩时	孕期增加值
发热组	74	27.4±2.9	161.6±4.4	39.8±1.0	0(0，0)	15(20.3)	21.4±2.8	27.5±2.9	6.1±2.1
对照组	906	26.8±3.2	162.5±4.8	39.6±1.0	0(0，0)	232(25.6)	20.9±2.8	26.9±3.2	5.9±2.2
统计量		t＝-1.67	t＝1.58	t＝-1.43	Z＝-0.74	χ²＝1.03	t＝-1.24	t＝-1.44	t＝-0.48
P值		0.096	0.114	0.153	0.462	0.309	0.216	0.149	0.631
组别	例数	妊娠合并症[例数(%)]		感染高危因素[例数(%)]		分娩入院时血常规(±s)
组别	例数	妊娠期高血压	妊娠期糖尿病	上呼吸道感染	B族链球菌感染	白细胞计数(×10⁹/L)	中性粒细胞百分比(%)	血红蛋白(g/L)
发热组	74	3(4.1)	16(21.6)	1(1.4)	0(0)	8.4±2.0	74.3±5.7	125.8±10.1
对照组	906	42(4.6)	124(13.7)	10(1.1)	16(1.8)	8.7±2.2	74.1±5.9	123.9±10.9
统计量		χ²<0.01^a	χ²＝3.52	—^b	χ²＝0.46^a	t＝1.37	t＝-0.23	t＝-1.46
P值		>0.999	0.061	0.380	0.499	0.171	0.816	0.144

表2 2组采取ELA产妇产时与产后相关资料比较

组别	例数	产程干预[例数(%)]				分娩方式[例数(%)]		第一产程时间(h，±s)	第二产程时间[h，M(Q₁，Q₃)]
组别	例数	人工破膜	ELARIF所致人工破膜	其他因素所致人工破膜	应用催产素	产钳助产	中转剖宫产	第一产程时间(h，±s)	第二产程时间[h，M(Q₁，Q₃)]
发热组	74	34(45.9)	4(5.4)	30(40.5)	48(64.9)	0(0)	20(27.0)	12.5±3.6	1.0(0.6，1.8)
对照组	906	278(30.7)	0(0)	278(30.7)	543(59.9)	22(2.4)	92(10.2)	9.8±3.5	0.7(0.5，1.1)
统计量		χ²＝7.34	—^a	χ²＝3.08	χ²＝0.69	χ²＝0.89^b	χ²＝19.24	t＝-5.50	Z＝-3.06
P值		0.007	<0.001	0.079	0.404	0.343	<0.001	<0.001	0.002
组别	例数	第三产程时间(min, ±s)	总产程时间[h，M(Q₁，Q₃)]	持续时间1^c(h, ±s)	持续时间2^d[h，M(Q₁，Q₃)]	产后发热[例数(%)]	24 h的产后出血量(mL, ±s)		顺产产妇PUR[例数(%)]^e
组别	例数	第三产程时间(min, ±s)	总产程时间[h，M(Q₁，Q₃)]	持续时间1^c(h, ±s)	持续时间2^d[h，M(Q₁，Q₃)]	产后发热[例数(%)]	顺产^e	中转剖宫产^f	顺产产妇PUR[例数(%)]^e
发热组	74	7.7±4.6	13.5(11.1，16.0)	7.1±2.5	6.3(4.9，7.6)	4(5.4)	393.0±107.6	383.9±60.1	10(18.5)
对照组	906	7.8±4.5	10.5(8.0，13.2)	5.8±2.5	4.6(3.1，6.3)	36(4.0)	375.9±133.5	433.6±148.6	56(6.9)
统计量		t＝0.24	Z＝-5.74	t＝-3.70	Z＝-5.01	χ²＝0.09^b	t＝-0.93	t＝1.43	χ²＝4.75^b
P值		0.812	<0.001	<0.001	<0.001	0.769	0.353	0.156	0.029
组别	例数	产后出血[例数(%)]		顺产产妇产后48~72 h血常规( ±s)^e			中转剖宫产术分娩产妇产后48~72 h血常规( ±s)^f
组别	例数	顺产^e	中转剖宫产^f	白细胞计数(×10⁹/L)	中性粒细胞百分比(%)	血红蛋白(g/L)	白细胞计数(×10⁹/L)	中性粒细胞百分比(%)	血红蛋白(g/L)
发热组	74	8(14.8)	0(0)	11.5±2.6	77.6±5.2	109.6±12.2	12.4±3.1	82.7±4.7	113.1±10.0
对照组	906	79(9.7)	2(2.2)	11.4±2.2	76.5±4.9	109.9±13.4	12.5±2.5	81.5±4.5	109.5±12.1
统计量		χ²＝1.35	—^a	t＝-0.20	t＝-1.57	t＝0.12	t＝-0.65	t＝-1.04	t＝-1.23
P值		0.246	0.850	0.840	0.116	0.905	0.519	0.299	0.222

表2 2组采取ELA产妇产时与产后相关资料比较

组别	例数	产程干预[例数(%)]				分娩方式[例数(%)]		第一产程时间(h，±s)	第二产程时间[h，M(Q₁，Q₃)]
组别	例数	人工破膜	ELARIF所致人工破膜	其他因素所致人工破膜	应用催产素	产钳助产	中转剖宫产	第一产程时间(h，±s)	第二产程时间[h，M(Q₁，Q₃)]
发热组	74	34(45.9)	4(5.4)	30(40.5)	48(64.9)	0(0)	20(27.0)	12.5±3.6	1.0(0.6，1.8)
对照组	906	278(30.7)	0(0)	278(30.7)	543(59.9)	22(2.4)	92(10.2)	9.8±3.5	0.7(0.5，1.1)
统计量		χ²＝7.34	—^a	χ²＝3.08	χ²＝0.69	χ²＝0.89^b	χ²＝19.24	t＝-5.50	Z＝-3.06
P值		0.007	<0.001	0.079	0.404	0.343	<0.001	<0.001	0.002
组别	例数	第三产程时间(min, ±s)	总产程时间[h，M(Q₁，Q₃)]	持续时间1^c(h, ±s)	持续时间2^d[h，M(Q₁，Q₃)]	产后发热[例数(%)]	24 h的产后出血量(mL, ±s)		顺产产妇PUR[例数(%)]^e
组别	例数	第三产程时间(min, ±s)	总产程时间[h，M(Q₁，Q₃)]	持续时间1^c(h, ±s)	持续时间2^d[h，M(Q₁，Q₃)]	产后发热[例数(%)]	顺产^e	中转剖宫产^f	顺产产妇PUR[例数(%)]^e
发热组	74	7.7±4.6	13.5(11.1，16.0)	7.1±2.5	6.3(4.9，7.6)	4(5.4)	393.0±107.6	383.9±60.1	10(18.5)
对照组	906	7.8±4.5	10.5(8.0，13.2)	5.8±2.5	4.6(3.1，6.3)	36(4.0)	375.9±133.5	433.6±148.6	56(6.9)
统计量		t＝0.24	Z＝-5.74	t＝-3.70	Z＝-5.01	χ²＝0.09^b	t＝-0.93	t＝1.43	χ²＝4.75^b
P值		0.812	<0.001	<0.001	<0.001	0.769	0.353	0.156	0.029
组别	例数	产后出血[例数(%)]		顺产产妇产后48~72 h血常规( ±s)^e			中转剖宫产术分娩产妇产后48~72 h血常规( ±s)^f
组别	例数	顺产^e	中转剖宫产^f	白细胞计数(×10⁹/L)	中性粒细胞百分比(%)	血红蛋白(g/L)	白细胞计数(×10⁹/L)	中性粒细胞百分比(%)	血红蛋白(g/L)
发热组	74	8(14.8)	0(0)	11.5±2.6	77.6±5.2	109.6±12.2	12.4±3.1	82.7±4.7	113.1±10.0
对照组	906	79(9.7)	2(2.2)	11.4±2.2	76.5±4.9	109.9±13.4	12.5±2.5	81.5±4.5	109.5±12.1
统计量		χ²＝1.35	—^a	t＝-0.20	t＝-1.57	t＝0.12	t＝-0.65	t＝-1.04	t＝-1.23
P值		0.246	0.850	0.840	0.116	0.905	0.519	0.299	0.222

表3 2组产妇ELA相关资料比较

组别	例数	ELA药物用量(mL，±s)		ELA持续时间[h，M(Q₁，Q₃)]	ELA后一过性胎心减速[例数(%)]^c	疼痛NRS评分(分)
组别	例数	顺产^a	中转剖宫产^b	ELA持续时间[h，M(Q₁，Q₃)]	ELA后一过性胎心减速[例数(%)]^c	ELA前(±s)	ELA后15 min[M(Q₁，Q₃)]	ELA结束时[M(Q₁，Q₃)]
发热组	74	53.0±19.9	39.9±24.2	4.8(3.8，6.3)	5(6.8)	9.0±0.8	1(1，1)	6(5，6)
对照组	906	32.1±17.9	37.1±24.9	3.6(2.3，5.3)	33(3.6)	9.0±0.7	1(1，1)	4(3，5)
统计量		t＝-8.18	t＝-0.45	Z＝-4.22	χ²＝1.04^d	t＝0.21	Z＝-0.06	Z＝-8.48
P值		<0.001	0.651	<0.001	0.307	0.834	0.948	<0.001

表3 2组产妇ELA相关资料比较

组别	例数	ELA药物用量(mL，±s)		ELA持续时间[h，M(Q₁，Q₃)]	ELA后一过性胎心减速[例数(%)]^c	疼痛NRS评分(分)
组别	例数	顺产^a	中转剖宫产^b	ELA持续时间[h，M(Q₁，Q₃)]	ELA后一过性胎心减速[例数(%)]^c	ELA前(±s)	ELA后15 min[M(Q₁，Q₃)]	ELA结束时[M(Q₁，Q₃)]
发热组	74	53.0±19.9	39.9±24.2	4.8(3.8，6.3)	5(6.8)	9.0±0.8	1(1，1)	6(5，6)
对照组	906	32.1±17.9	37.1±24.9	3.6(2.3，5.3)	33(3.6)	9.0±0.7	1(1，1)	4(3，5)
统计量		t＝-8.18	t＝-0.45	Z＝-4.22	χ²＝1.04^d	t＝0.21	Z＝-0.06	Z＝-8.48
P值		<0.001	0.651	<0.001	0.307	0.834	0.948	<0.001

表4 2组采取ELA产妇分娩新生儿相关资料比较

组别	例数	出生体重(kg/m²，±s)	羊水粪染[例数(%)]	胎儿窘迫[例数(%)]	新生儿窒息[例数(%)]	入住NICU[例数(%)]
发热组	74	3 472.1±364.3	23(31.1)	11(14.9)	0(0)	0(0)
对照组	906	3 410.5±364.3	191(21.1)	54(6.0)	4(0.4)	4(0.4)
统计量		t＝-1.40	χ²＝4.01	χ²＝7.38^a	—^b	—^b
P值		0.162	0.045	0.007	0.730	0.730
组别	例数	Apgar评分[例数(%)]		转入新生儿科原因[例数(%)]
组别	例数	生后1 min<9分	生后5 min<10分	黄疸	感染	其他
发热组	74	6(8.1)	8(10.8)	3(4.1)	11(14.9)	5(6.8)
对照组	906	38(4.2)	42(4.6)	50(5.5)	64(7.1)	33(3.6)
统计量		χ²＝1.62^a	χ²＝4.19^a	χ²＝0.07^a	χ²＝5.89	χ²＝1.04^a
P值		0.204	0.041	0.788	0.015	0.307

表4 2组采取ELA产妇分娩新生儿相关资料比较

组别	例数	出生体重(kg/m²，±s)	羊水粪染[例数(%)]	胎儿窘迫[例数(%)]	新生儿窒息[例数(%)]	入住NICU[例数(%)]
发热组	74	3 472.1±364.3	23(31.1)	11(14.9)	0(0)	0(0)
对照组	906	3 410.5±364.3	191(21.1)	54(6.0)	4(0.4)	4(0.4)
统计量		t＝-1.40	χ²＝4.01	χ²＝7.38^a	—^b	—^b
P值		0.162	0.045	0.007	0.730	0.730
组别	例数	Apgar评分[例数(%)]		转入新生儿科原因[例数(%)]
组别	例数	生后1 min<9分	生后5 min<10分	黄疸	感染	其他
发热组	74	6(8.1)	8(10.8)	3(4.1)	11(14.9)	5(6.8)
对照组	906	38(4.2)	42(4.6)	50(5.5)	64(7.1)	33(3.6)
统计量		χ²＝1.62^a	χ²＝4.19^a	χ²＝0.07^a	χ²＝5.89	χ²＝1.04^a
P值		0.204	0.041	0.788	0.015	0.307

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