Reason Analysis Of Intrapartum Fever After Epidural Analgesia And The Effect On Fetal Birth Status And Short-term Prognosis

Objective:To investigate the causes of fever during childbirth after epidural analgesia and its influence on fetal birth status and short-term prognosis,and to explore the expression changes of IL-6 and HSP70 in maternal circulation and umbilical arterial blood.Methods:60 pregnant women who underwent epidural analgesia during childbirth and vaginal delivery in Jiangxi Maternal and Child Health Hospital from June 2022 to October 2022 were studied.Ear temperature was measured every 2 hours after epidural analgesia.They were divided into fever group（28 cases）and control group（32 cases）according to whether there was fever before childbirth（ear temperature≥37.6℃）.Visual analog scale（VAS）,duration of labor,duration of labor analgesia,antibiotic use,use rate of instrumental midwife,number of internal cervical opening examination and intrapartum hemorrhage were recorded and compared between the two groups.2ml of maternal venous blood and 2ml of fetal umbilical arterial blood were collected from T₁（before labor analgesia）,T₂（full time cervical opening）and T₃（24 hours postpartum）,and the expression levels of IL-6 and HSP70 were detected,and blood gas analysis was performed in umbilical arterial blood.Apgar score,sex,blood gas index of umbilical artery,neonatal destination,complications,length of stay and short-term prognosis of the two groups were analyzed and compared.Results:（1）The body temperature of both groups began to rise 2 hours after delivery analgesia,and returned to normal 24 hours after delivery.At 2h,4h,6h,8h after labor analgesia and 2h postpartum,the fever body temperature was higher than that of the control group,and the difference was statistically significant（all P<0.05）.There were no significant differences in VAS scores between the two groups at each time point（P>0.05）.（2）There was no significant difference in the duration of the first stage of labor,the second stage of labor,the third stage of labor and the duration from water breaking to labor between the two groups（all P>0.05）.The duration of labor analgesia in the fever group was greater than that in the control group,and the difference was statistically significant（P<0.05）.There was no significant difference in the number of endocervical examinations between the two groups（P>0.05）.The amniotic fluid contamination rate in the fever group was higher than that in the control group,and the proportion of antibiotic use was also higher,the differences were statistically significant（all P<0.05）.The rate of lateral perineal resection in fever group was higher than control group,and the difference was statistically significant（P<0.05）.There were no significant differences in blood loss and forceps use rate between the two groups（all P>0.05）.（3）Although the incidence of fetal distress was higher in the fever group than in the control group（P<0.05）,but there was no significant difference in Apgar scores at1min,5min and 10min between the two groups（P>0.05）.There were no significant differences in blood Ph,PO2 and PCO2 between the two groups（P>0.05）.The proportion of newborns transferred from delivery room to neonatal unit in fever group was higher than that in control group（P<0.05）,and the hospitalization time of newborns in fever group was longer than that in control group（P<0.05）.The proportion of perinatal idiopathic infection was higher in the fever group than in the control group,and the difference was statistically significant（P<0.05）.After one month’s follow-up,the neonatal survival rate of both groups was 100%.The incidence of neonatal hyperbilirubinemia in the fever group was higher than that in the control group,and the difference was statistically significant（P<0.05）.（4）There was no significant difference in the expression of maternal circulating HSP 70 between the two groups at each time point（P<0.05）,there was no significant difference in the expression of HSP 70 in umbilical arterial blood between the two groups（P>0.05）.Compared with T₁,the expression level of circulating HSP 70 in both groups increased at T₂,and the difference was statistically significant（P<0.05）.（5）There was no significant difference in circulating IL-6 levels between the tow groups at T₁（P>0.05）.Compared with T₁,the expression of IL-6 was significantly increased in both groups at T₂（all P<0.05）,and the level of IL-6 in fever group was higher than that in control group,the difference was statistically significant（P<0.05）.The expression of IL-6 in both groups recovered to T₁level at T₃（P>0.05）.There was no significant difference in IL-6 levels between the two groups（P>0.05）.Conclusion:（1）Duration of labor analgesia and amniotic fluid contamination are risk factors for intrapartum fever after epidural labor analgesia.（2）Inflammatory response（IL-6）plays an important role in the occurrence and development of fever during childbirth after epidural analgesia.（3）Fever during labor after epidural analgesia increases the risk of antibiotic exposure and the chance of lateral perineal incision during labor.（4）Intrapartum fever after epidural analgesia has no significant adverse effect on Apgar score and umbilical arterial blood gas indices at birth,but increases the risk of idiopathic perinatal infection at birth and transfer to the neonatal unit within 48h after birth,and also increases the length of neonatal stay and the incidence of neonatal hyperbilirubinemia.（5）The expression of immune and inflammatory factors（HSP70,IL-6）increased during labor.