Investigation On Risk Factors Of Intraspinal Labor Analgesia And Intraparinatal Fever And Its Influence On Neonates

Objective:This study aims to investigate the risk factors associated with intrapartum fever and its impact on neonatal outcomes among primary women who underwent neuraxial delivery analgesia.Methods:1、A total of 691 primiparous women who underwent vaginal delivery at the Second Affiliated Hospital of Guilin Medical College between September2020 and August 2021 were included in this study.Of these,430 women who received neuraxial analgesia during delivery were designated as the analgesia group,while 261 women who did not receive neuraxial analgesia were designated as the non-analgesic group.The incidence of intrapartum fever was compared between the two groups.2、Additionally,82 primiparous women who developed intrapartum fever after spinal canal labor analgesia were included as another fever group,and 348 primiparous women who did not develop intrapartum fever after spinal canal labor analgesia were included as another non-febrile group.According to whether the patient has axillary body temperature ≥ 38 ℃ after intraspinal labor analgesia,the fever during labor was judged.The following data of all parturients were collected:(1)General information: Data on age,gestational age,prenatal temperature,blood picture,body mass index(BMI),and other relevant factors were collected for two groups of pregnant women.(2)Pregnancy complications: A comparison was made between the two groups with regard to pregnancy complications such as anemia,gestational hypertension,and gestational diabetes.(3)Intrapartum factors: The time from fetal membrane rupture to fetal delivery,length of labor,number of vaginal examinations,fetal delivery time caused by labor analgesia,amniotic fluid pollution rate,time from anesthesia to fever,oxytocin use,antibiotic use,intrapartum and postpartum hemogram,midwifery rate,local anesthetic concentration,neonatal transfer rate,neonatal Apgar score,etc,were compared.Clinical data from the observation and control groups were analyzed.SPSS28.0 software was used for statistical analysis of the data.A univariate analysis of possible influencing factors was performed.Independent sample t-tests were used for comparison.Relevant data with statistically significant differences in univariate analysis were selected for Logic regression analysis.Results:1.Between September 2020 and August 2021,430 mothers underwent neuraxial delivery analgesia,with 82 cases of intrapartum fever resulting in an incidence rate of 19.1%.Among the 261 cases without neuraxial delivery,5cases of fever occurred at the time of delivery,resulting in an incidence rate of1.9%.The incidence rate of fever during childbirth was significantly higher in mothers who underwent neuraxial delivery analgesia compared to those who did not(p<0.01).2.In the basic data comparison of the two groups of women who underwent neuraxial delivery analgesia,there was a statistical difference in age comparison(p<0.05);In terms of maternal comorbidities,the incidence of anemia was found to be significantly higher in the fever group compared to the control group(p<0.05);In the comparison of different situations during delivery,gestational week,amniotic fluid pollution rate,BMI,the incidence of premature rupture of membranes,local anesthetic concentration,midwifery rate,neonatal Apgar score of 5 minutes and 10 minutes,GDM and pregnancy-induced hypertension were not statistically significant(p>0.05).Age,pregnancy with anemia,frequency of vaginal examinations,duration of labor,time from rupture of the membrane to fetal delivery,time from anesthesia to fetal delivery,intrapartum hemogram,and neonatal 1-minute Apgar score were statistically significant(p<0.05);there was no significant difference observed in the use of oxytocin between the two groups(p>0.05);the rate of antibiotic application was found to be higher in the fever group compared to the control group(p<0.05);there was no significant difference in prenatal and postpartum hemogram between the two groups(p>0.05).Binary logistics analysis showed that the time from membrane rupture to fetal delivery(OR = 1.001,95% CL 1.000～1.001,p =0.1),anesthesia to fetal delivery(OR = 1.001,95% CL 1.001～1.002,p = 0.191),anemia(OR = 2.464,95% CL is 0.836～7.260,p = 0.102),duration of labor(OR =1.0,95% CL is 0.999～1.001,p = 0.387)has no obvious positive influence on fever during labor.However,the number of vaginal examinations(OR =1.472,95% CL is 1.258～1.722,p = 0.000),age(OR = 1.095,95% CL is1.022～1.173,p = 0.01)has a significant positive effect on intrapartum fever.Conclusion:1.In the process of intraspinal labor analgesia,when using spinal canal labor analgesia,the incidence of intrapartum fever is higher when compared to non-spinal canal delivery.2.In the comparison of febrile factors during spinal canal delivery analgesia,pregnancy complicated with anemia,frequency of vaginal examination,time of labor,time from rupture of fetal membranes to delivery of the fetus,time from anesthesia to delivery of the fetus,and age is independent risk factors for maternal fever during delivery.3.Intraspinal labor analgesia and fever during delivery specifically influence neonatal transfer rate and neonatal Apgar1 minute score.Based on the above research results,clinically,specific preventive measures should be given to women with long labor duration,long rupture time,and advanced age of painless delivery.The number of vaginal examinations should be minimized,the time to labor analgesia and the rupture of membranes to delivery should be minimized,and abnormal labor should be actively managed.In addition,reasonable fluid replacement,oxygen,drug antipyretic,etc.,should also be used to reduce the adverse effects of intrapartum fever on the mother and fetus to ensure the safety of the mother and baby.