Fever during labour epidural analgesia

Maternal fever during labour epidural analgesia is not uncommon and could be associated with potential neonatal and maternal sequelae. Proposed mechanisms of epidural fever include disequilibrium of thermoregulation, infection or inflammation caused by either mechanical or drug related factors. Current evidence suggest that a primary acute inflammatory response with potential secondary inflammatory releasing mediators could be the most plausible pathophysiology. Potential management options include reducing the duration of labour or by reducing inflammatory process. However, studies involving use of steroids to reduce inflammation have found an increased risk of asymptomatic neonatal bacteraemia. Paracetamol has also not been found to prevent maternal epidural fever. Further research is required to understand the process mechanisms so that associated neonatal and maternal complications could be reduced.