Does Epidural Administration During Labor Contribute to Adverse Neonatal Outcomes?
Bethany Kaemingk, MSIII & Annah Prezzler, MSIII
Faculty Advisor: James R. Beal, Ph.D.
4. Approximately 4 million women give birth in the United States each year, and >60% receive
intrapartum epidural analgesia.1 Although epidural analgesia is generally considered a safe and
effective method of pain relief during labor, both randomized trials and observational studies
consistently demonstrate an association between epidural analgesia and maternal fever during
labor.1,2 Intrapartum maternal fever has been shown to be associated with adverse neonatal
outcomes including hypotonia, assisted ventilation, 1- and 5-minute Apgar scores <7, and earlyonset seizures.1 The aim of this study is to determine the association between epidural-related
intrapartum maternal fever and adverse neonatal outcomes in low-risk women. .
5-7, 9. We will perform a retrospective analysis of medical charts (n=300) of women who have
given birth with and without epidural analgesia from January 1-December 31, 2012 at St.
Alexius Medical Center, North Dakota, USA. Neonatal outcomes will be compared between
women receiving and not receiving epidural analgesia as well as if they have intrapartum
temperature elevation (≥99.5°F/37.5°C). Included will be nulliparous women with
uncomplicated pregnancies who delivered at term (defined as 38-41 weeks) and via spontaneous
labor with fetuses in the vertex position. Exclusion criteria will any women with maternal
alcohol, tobacco, or illicit drug use during pregnancy. Also, any women with macrosomia
infants (4000gms) or infants with congenital anomalies will be excluded.
Data to be recorded will include: maternal age, maternal BMI (pre and delivery), maternal
comorbidities, gestational age, gestational weight, labor epidural administration, intrapartum
maternal temperature, type of delivery, length of delivery, induced delivery, delivery
complications (including rupture of membranes), instrument delivery (vacuum and/or forceps),
neonatal complications (including fetal distress and ventilation), antibiotic use, Apgar scores.
SPSS 21.0 for Windows will be used to analyze demographic and clinical characteristics of
patients. Frequencies and relative percentages will be computed for each categorical variable.
Chi-square tests or fisher’s exact tests will be performed to determine which categories were
significantly different from one another, and t-test and/or ANOVA will be used to compare
continuous variables. All p-values will be two-sided, and p-value <0.05 will be considered
significant. Missing data will be excluded from analysis.
8 & 10. For the purpose of this study, there will be no physical interaction between the principal
investigators and the patients whose charts are being reviewed. Furthermore, no procedures will
be performed or direct interaction will occur with patients of this study. Data will be stored
securely on password protected computers and files. The data file will not contain any
identifying information such as patients’ names or medical record numbers. Only those
involved in the research project will be able to access the data. Data will be stored in the
Department of Family and Community Medicine at the UND School of Medicine and Health
Sciences for a period of six years after analysis.
REFERENCES
1. Greenwell EA, Wyshak G, Ringer SA, Johnson LC, Rivkin MJ, Lieberman E.
Intrapartum Temperature Elevation, Epidural Use, and Adverse Outcome in Term
Infants. Pediatrics 2012; 129: e447-e454.
2. Leighton BL, Halpern SH. Epidural Analgesia: Effects on Labor Progress and Maternal
and Neonatal Outcome. Seminars in Parinatology 2002; 2: 122-135.