Logistic Regression Analysis Of Factors Affecting Maternal Fever During Epidural Labor Analgesia

Objective:To analyze the influencing factors of intrapartum fever during epidural labor analgesia and the influence of intrapartum fever on neonates.Methods:A total of 2051 parturient with epidural labor analgesia in our hospital from January 2019 to October 2019 were selected,the electronic case system was used to extract relevant data for retrospective analysis.The parturient ASA classification isⅡ～Ⅲ,age 20～44 years,height 148～178cm,weight 43～109kg,gestational age37～41⁺⁶ weeks.Extract the following data from parturient cases:（1）Basic information:The maternal age,height,weight,gestational age,whether it is a primipara and ASA classification,and parturient BMI are calculated by the researcher based on their weight and height;（2）Date of delivery:The highest body temperature measured after epidural labor analgesia in the delivery room greater than 37.5℃,duration of labor,duration of epidural analgesia（from the implementation of epidural analgesia to the end of the third stage of labor）,whether the membranes rupture prematurely,time from rupture of membrane to delivery,whether the number of vaginal examinations is more than 6 times,whether the amniotic fluid is polluted,whether to use oxytocin during labor,dilation of the parturient uterine orifice during the implementation of epidural labor analgesia;（3）Neonates data:1min and 5min Apgar scores of the neonates,weight at birth and whether to be transferred to the neonatal intensive care unit.According to whether the maximum body temperature measured in the delivery room during the delivery room after epidural labor analgesia was greater than 37.5℃,they were divided into fever group（group F）:495 cases and normal body temperature group（group C）:1556 cases.First,perform univariate analysis of whether the basic parturient information is a primipara,BMI,all data of delivery,and newborn weight at birth in the neonate data,the independent sample t test was used to compare the above data in the two groups of parturient,select data with statistically significant differences in univariate analysis for binary logistic regression analysis,find out the influencing factors of the intrapartum fever during the epidural labor analgesia,the receiver operating characteristic curve was used to further compare the sensitivity and specificity of the above related influencing factors in predicting intrapartum fever after epidural labor analgesia,the final analysis of the effect of maternal intrapartum fever on the full score rate of the Apgar score of 1min and 5min of neonates and whether to transfer to the neonatal intensive care unit.Results:1.A total of 3011 parturients were included,536 were excluded,424 were excluded,and the remaining 2051 parturients were included in the retrospective analysis.2.There was no significant difference in age,height,weight and gestational age between the two groups of parturients（P>0.05）.3.In univariate analysis,there was no statistically significant difference between the two groups of parturients in whether they were primipara,BMI,amniotic fluid pollution,whether to use oxytocin during labor,and uterine orifice dilation during epidural labor analgesia（P>0.05）.4.In univariate analysis,compared with group C,the duration of labor,duration of epidural analgesia and the time from rupture of membranes to delivery were increased in group F（P<0.05）;Compared with group C,the proportion of pregnant women with premature rupture of membranes and the proportion of vaginal examinations more than 6 times in group F increased（P<0.05）,the difference was statistically significant.5.Binary Logistic regression analysis showed that premature rupture of membranes（OR=2.008,95%CI:1.551～2.600）,vaginal examination performed more than 6 times（OR=1.681,95%CI:1.286～2.197）,duration of labor（OR=1.090,95%CI:1.063～1.118）,and time from rupture of membranes to delivery（OR=1.048,95%CI:1.010～1.087）were all risk factors for intrapartum fever in pregnant women with epidural labor analgesia.6.The area under the curve for premature rupture of membranes was 0.434（95%CI:0.404～0.464,P<0.05）,and the area under the curve for vaginal examination performed more than 6 times was 0.470（95%CI:0.441～0.500,P<0.05）,the area under the curve for time from rupture of membranes to delivery was 0.613（95%CI:0.587～0.639,P<0.05）,and the area under the curve for duration of labor was 0.671（95%CI:0.645～0.696,P<0.05）.7.The cut-off value of labor time was 11.79h,and its sensitivity and specificity for predicting intrapartum fever during epidural labor analgesia were 71.5% and 56.4,respectively.The cut-off value of the time from rupture of membranes to delivery was 5.315h,and the sensitivity and specificity for predicting intrapartum fever during epidural labor analgesia were 87.3%and 38.1%,respectively.8.Compared with group C,the full score rate of Apgar scores of newborns in group F decreased at 1 min and 5 min,and the difference was statistically significant（P<0.05）;Compared with group C,there was no statistically significant difference in the transfer rate of neonatal intensive care unit in group F（P>0.05）.Conclusion:In the process of epidural analgesia during labor,the influencing factors of intrapartum fever were labor time more than 11.79h,number of vaginal examinations more than 6 times,premature rupture of membranes and rupture of membranes to delivery time more than 5.315 h.Time from rupture of membranes to delivery is highly sensitive to predicting maternal intrapartum fever during epidural labor analgesia.Although intrapartum fever in the parturients had a significant influence on the number of neonates with Apgar score of 10,will not affect the outcome of the neonates.