Pregnancy
Conditions
Brief 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.
Interventions
OTHERLabor analgesia
Measuring maternal ventilation after placement of epidural analgesia compared to baseline
Sponsors
Brigham and Women's Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
1. Parturient with no major co-morbidities 2. Singleton, vertex gestation at term (38-42 weeks) 3. Less than 5 cm dilation 4. Intact fetal membranes or rupture for \< 6 hrs. 5. Desire to have an epidural technique for labor analgesia
Exclusion criteria
1. Current or historical evidence of clinically significant disease or condition, including diseases of pregnancy (i.e preeclampsia, gestational diabetes) 2. Any contraindication to the administration of an epidural technique 3. History of hypersensitivity or idiosyncratic reaction to local anesthetic or opioid medications 4. Current or historical evidence of a disease which may result in the risk of a cesarean delivery (i.e. vaginal birth after cesarean section, history of uterine rupture) 5. Evidence of anticipated fetal anomalies 6. Signs or symptoms consistent with an infection or sepsis; baseline temperature \< 37 degrees Celsius, or 99 degrees Fahrenheit.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in Maternal Ventilation During Labor Analgesia | Ventilation parameters measured at 2 hour and 4 hour | If Maternal Ventilation decreases following labor analgesia at 2 hour and 4 interval |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| If Maternal Temperature Increases During Labor Analgesia | 4 hours | If maternal temperature increases during labor analgesia |
Countries
United States
Participant flow
Recruitment details
Following approval by our Institutional Review Board, written consent was obtained from 57 healthy, full-term women undergoing elective induction of labor who expressed interest in receiving epidural analgesia.
Participants by arm
| Arm | Count |
|---|---|
| Study Group We are simply measuring ventilation changes that occur following labor analgesia.
Labor analgesia: Measuring maternal ventilation after placement of epidural analgesia compared to baseline | 57 |
| Total | 57 |
Baseline characteristics
| Characteristic | Study Group |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 57 Participants |
| Region of Enrollment United States | 57 participants |
| Sex: Female, Male Female | 57 Participants |
| Sex: Female, Male Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 57 |
| other Total, other adverse events | 0 / 57 |
| serious Total, serious adverse events | 0 / 57 |
Outcome results
Primary
Changes in Maternal Ventilation During Labor Analgesia
If Maternal Ventilation decreases following labor analgesia at 2 hour and 4 interval
Time frame: Ventilation parameters measured at 2 hour and 4 hour
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Study Group | Changes in Maternal Ventilation During Labor Analgesia | Maternal ventilation at baseline | 15.3 L/min | Standard Deviation 1 |
| Study Group | Changes in Maternal Ventilation During Labor Analgesia | Maternal ventilation at 2 hours | 12.6 L/min | Standard Deviation 1.1 |
| Study Group | Changes in Maternal Ventilation During Labor Analgesia | Maternal Ventilation at 4 hor | 13.8 L/min | Standard Deviation 1.2 |
Secondary
If Maternal Temperature Increases During Labor Analgesia
If maternal temperature increases during labor analgesia
Time frame: 4 hours
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Study Group | If Maternal Temperature Increases During Labor Analgesia | Temperature at 4 hour | 98.7 Degree F | Standard Deviation 0.5 |
| Study Group | If Maternal Temperature Increases During Labor Analgesia | baseline temperature | 98.1 Degree F | Standard Deviation 0.4 |