Concerned topics of epidural labor analgesia:labor elongation and maternal pyrexia:a systematic review

作     者：Cai-Juan Li Fan Xia Shi-Qin Xu Xiao-Feng Shen Li Cai-Juan;Xia Fan;Xu Shi-Qin;Shen Xiao-Feng

作者机构：Department of AnesthesiologyWomen’s Hospital of Nanjing Medical UniversityNanjing Maternity and Child Health Care HospitalNanjingJiangsu 210004China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2020年第133卷第5期

页      面：597-605页

核心收录：

学科分类：1002[医学-临床医学] 100211[医学-妇产科学] 10[医学] 

基　　金：supported by the grants from the National Natural Scientific Foundation of China(No.81500944) the Nanjing Municipal Health Bureau General Project(No.YKK14127). 

主　　题：Epidural analgesia Labor process Maternal pyrexia Intrapartum fever Mechanism 

摘      要：Objective:Labor is a complex process and labor pain presents challenges for analgesia.Epidural analgesia(EA)has a well-known analgesic effect and is commonly used during labor.This review summarized frequently encountered and controversial problems surrounding EA during labor,including the labor process and maternal intrapartum fever,to build knowledge in this area.Data sources:We searched for relevant articles published up to 2019 in PubMed using a range of search terms(eg,“labor pain,“epidural,“analgesia,“labor process,“maternal pyrexia,“intrapartum fever).Study selection:The search returned 835 articles,including randomized control trials,retrospective cohort studies,observational studies,and reviews.The articles were screened by title,abstract,and then full-text,with a sample independently screened by two authors.Thirty-eight articles were included in our final analysis;20 articles concerned the labor process and 18 reported on maternal pyrexia during EA.Results:Four classic prospective studies including 14,326 participants compared early and delayed initiation of EA by the incidence of cesarean delivery.Early initiation following an analgesia request was preferred.However,it was controversial whether continuous use of EA in the second stage of labor induced adverse maternal and neonatal outcomes due to changes in analgesic and epidural infusion regimens.There was a high incidence of maternal pyrexia in women receiving EA and women with placental inflammation or histologic chorioamnionitis compared with those receiving systemic opioids.Conclusions:Early EA(cervical dilation≥1 cm)does not increase the risk for cesarean section.Continuous epidural application of low doses of analgesics and programmed intermittent epidural bolus do not prolong second-stage labor duration or impact maternal and neonatal outcomes.The association between EA and maternal pyrexia remains controversial,but pyrexia is more common with EA than without.A non-infectious inflammatory process is an accepted mechanism of epidural-related maternal fever.