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Maternal Epidural Analgesia and Rates of Maternal Antibiotic Treatment in a Low-risk Nulliparous Population

Journal of Perinatology volume 23, pages 457–461 (2003)Cite this article

Abstract

BACKGROUND: Epidural analgesia is associated with an increased rate of fever in prospective randomized trials. While the evidence suggests that epidural fever is not infectious, epidural analgesia has been associated with increased rates of antibiotic use, the indications that prompt treatment have not been examined.

METHODS: We analyzed 1235 nulliparous women with singleton term pregnancies presenting in labor with a temperature of <99.5°F. Antibiotic use during labor was categorized by indication.

RESULTS: A total of 59.6% of women received epidural analgesia. The rate of antibiotic use was significantly higher in women receiving epidural analgesia (28 vs 10.8%). After adjusting for confounders using logistic regression, epidural analgesia was associated with a relative risk of 2.6 (95% CI 2.0, 3.4) for antibiotic treatment. The majority of the increased risk was due to significantly higher rates of antibiotic treatment for presumed chorioamnionitis (9.0 vs 0.4%) in the epidural analgesia group.

CONCLUSION: Epidural-related fever results in excess maternal antibiotic treatment for presumed chorioamnionitis.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA

    Laura Goetzl MD, MPH

  2. Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA

    Amy Cohen BS & Ellice Lieberman MD, DrPH

  3. Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Fredric Frigoletto Jr MD

  4. Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA, USA

    Janet M Lang PhD, ScD

Authors
  1. Laura Goetzl MD, MPH
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  2. Amy Cohen BS
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  3. Fredric Frigoletto Jr MD
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  4. Janet M Lang PhD, ScD
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  5. Ellice Lieberman MD, DrPH
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Additional information

Supported by National Institute of Health and Human Development Grant no. RO1-HD26813.

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Goetzl, L., Cohen, A., Frigoletto, F. et al. Maternal Epidural Analgesia and Rates of Maternal Antibiotic Treatment in a Low-risk Nulliparous Population. J Perinatol 23, 457–461 (2003). https://doi.org/10.1038/sj.jp.7210967

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