Combined spinal and epidural anaesthesia and maternal intrapartum temperature during vaginal delivery: a randomized clinical trial.

BACKGROUND We determined the association between combined spinal-epidural (CSE) anaesthesia and an increase in maternal intrapartum temperature and intrapartum fever. METHODS A randomized, open clinical trial was performed with 70 pregnant women, 35 receiving CSE and 35 receiving only non-pharmacological methods of pain relief during delivery. Association between CSE and changes in the patient's temperature, the risk of maternal fever, and other maternal and perinatal outcomes was determined at a 5% significance level. Number needed to harm (NNH) was calculated for maternal fever. RESULTS Patients receiving CSE anaesthesia during vaginal delivery experienced a significant increase in intrapartum temperature and five (14%) developed fever, whereas no cases occurred in the group receiving only non-pharmacological methods of pain relief (P=0.027). None of the women who developed fever received antibiotics or were submitted to further investigation; however, all progressed without complication. No case of chorioamnionitis or any maternal or neonatal infection was detected. NNH for maternal fever was 7.0 (95% confidence interval: 3.8-51.9). CONCLUSIONS The use of CSE is associated with a significant increase in maternal temperature and in the incidence of intrapartum maternal fever. However, the increase in maternal temperature does not appear to provoke any deleterious effects on the mother or child.