Cartledge, A., Hind, D. orcid.org/0000-0002-6409-4793, Bradburn, M. orcid.org/0000-0002-3783-9761 et al. (6 more authors) (2022) Interventions for the prevention or treatment of epidural-related maternal fever : a systematic review and meta-analysis. British Journal of Anaesthesia, 129 (4). pp. 567-580. ISSN 0007-0912
Abstract
Background
Epidural-related maternal fever has consequences for the mother and neonate. There has been no systematic review of preventive strategies.
Methods
RCTs evaluating methods of preventing or treating epidural-related maternal fever in women in active labour were eligible. We searched MEDLINE, EMBASE, CINAHL, Web of Science, CENTRAL, and grey literature sources were searched from inception to April 2021. Two review authors independently undertook study selection. Data extraction and quality assessment was performed by a single author and checked by a second. The Cochrane Risk of Bias 2 tool was used. Meta-analyses for the primary outcome, incidence of intrapartum fever, were performed using the DerSimonian and Laird random effects model to produce summary risk ratios (RRs) with 95% confidence intervals (95% CIs).
Results
Forty-two records, representing 34 studies, were included. Methods of reduced dose epidural reduced the incidence of intrapartum fever, but this was not statistically significant when six trials at high risk of bias were removed (seven trials; 857 participants; RR=0.83; 95% CI, 0.41–1.67). Alternative methods of analgesia and high-dose prophylactic systemic steroids reduced the risk of intrapartum fever compared with epidural analgesia. Prophylactic paracetamol was not effective.
Conclusions
There is no clear evidence to support the use of any individual preventative or therapeutic intervention for epidural-related maternal fever. Further research should focus on understanding the mechanism of fever development to enable RCTs of potential interventions to reduce the incidence of intrapartum fever development and the subsequent disease burden felt by the neonate.
Clinical trial registration
CRD42021246929.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2022 The Author(s). Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
Keywords: | epidural fever; epidural-related maternal fever; intrapartum fever; labour analgesia; labour epidural; perinatal analgesia |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 10 Aug 2022 13:03 |
Last Modified: | 27 Feb 2023 11:21 |
Status: | Published |
Publisher: | Elsevier BV |
Refereed: | Yes |
Identification Number: | 10.1016/j.bja.2022.06.022 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:189884 |