Association of epidural-related fever and noninfectious inflammation in term labor

Obstet Gynecol. 2011 Mar;117(3):588-595. doi: 10.1097/AOG.0b013e31820b0503.


Objective: To investigate the role of infection and noninfectious inflammation in epidural analgesia-related fever.

Methods: This was an observational analysis of placental cultures and serum admission and postpartum cytokine levels obtained from 200 women at low risk recruited during the prenatal period.

Results: Women receiving labor epidural analgesia had fever develop more frequently (22.7% compared with 6% no epidural; P=.009) but were not more likely to have placental infection (4.7% epidural, 4.0% no epidural; P>.99). Infection was similar regardless of maternal fever (5.4% febrile, 4.3% afebrile; P=.7). Median admission interleukin (IL)-6 levels did not differ according to later epidural (3.2 pg/mL compared with 1.6 pg/mL no epidural; P=.2), but admission IL-6 levels greater than 11 pg/mL were associated with an increase in fever among epidural users (36.4% compared with 15.7% for 11 pg/mL or less; P=.008). At delivery, both febrile and afebrile women receiving epidural had higher IL-6 levels than women not receiving analgesia.

Conclusion: Epidural-related fever is rarely attributable to infection but is associated with an inflammatory state.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Anesthesia, Epidural / adverse effects*
  • Cytokines / blood
  • Female
  • Fever / etiology*
  • Humans
  • Logistic Models
  • Pregnancy
  • Puerperal Infection / etiology*
  • Term Birth


  • Cytokines