What is the relationship between epidural anesthesia and chorioamnionitis?

Updated: May 08, 2018
  • Author: Fayez M Bany-Mohammed, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Answer

The adverse effects of epidural anesthesia on the mother and her newborn continue to be unresolved issues. Labor may be prolonged by epidural anesthesia [151] ; thus, mothers who receive this type of anesthesia may become dehydrated and exhausted, and they may also develop an elevated temperature. [152]  In turn, their fetus may have an increased heart rate associated with epidural anesthesia and maternal fever. The presence of maternal fever and fetal tachycardia initiate an investigation of the cause, and the obstetrician often administers antibiotics. Intermittent labor analgesia reduces the incidence of maternal fever more than continuous epidural analgesia. [153] Epidural-related fever is rarely attributable to intraamniotic infection, but it is often associated with sterile inflammation and elevation in interleukin (IL)-6)levels in maternal blood (see the discussion under Physical Examination). [154]

The neonate may be born in a febrile state. [155] Typically, newborns appear and act healthy after intrapartum epidural anesthesia. Elevated temperature in neonates rapidly returns to normal in babies without infection. Controversy surrounds conducting an evaluation for sepsis in neonates with this history. A minority of pediatricians or family practitioners may elect to perform an evaluation for sepsis and treat for 48 hours with antibiotics pending the culture results.

Despite the observation that most febrile infants are well after a mother has epidural anesthesia during labor, an assessment nevertheless should be cautious.


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