Best Practices for The Management of Epidural-Related Maternal Fever: A Systematic Review and Meta-Analysis

Abstract

Abstract Background: Epidural analgesia (EA) is associated with intrapartum fever (IF), which can cause adverse consequences for mothers and neonates. Establishing interventions and approaches that could help to address EA-related IF and limit its associated adverse outcomes is therefore crucial. Aim: To identify best practices for preventing the incidence of EA-related maternal fever to ensure the best outcomes for mothers and neonates. Methods: This study utilised a systematic review and meta-analysis approach to analyse evidence and describe the evidence of published literature. Articles were retrieved from PubMed, CINAHL, and EMBASE between 18 and 29 June 2021. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and the meta-analysis was carried out using RevMan 5.4. Eligible studies included randomised controlled trials and observational cohort published not later than 2011. Pregnant women with clinically diagnosed EA-related fever were included. Risk of bias (ROB) was assessed using the Cochrane ROB-2 and ROBINS in Non-Randomised Studies of Interventions. Results: Twelve articles with a total of 555,786 births and 2,992 women participants were reviewed. The results revealed that health care practitioners must be cautious when administering EA because of the risk of adverse health consequences, as indicated by low Apgar scores (<7). EA-related IF occurred despite the prophylactic administration of antibiotics. The review also noted that a longer duration of EA administration could increase the risk of IF (odd ratios, 1.88, 95% CI: 0.96–2.80). A high concentration of EA was also associated with an increased risk of IF. Conclusion: Healthcare practitioners must focus on the duration and the concentration of EA. This review demonstrates that the use of prophylactic antibiotics to manage analgesia-related IF must be cautiously practised to ensure that the benefits outweigh the risks of antibiotic use.