• Laura Goetzl, Amy Cohen, Fredric Frigoletto, Janet M Lang, and Ellice Lieberman.
• Department of Obstetrics and Gynecology, Baylor College of Medicine, 6550 Fannin Street, Suite 901, Houston, TX 77030, USA.
• J Perinatol. 2003 Sep 1;23(6):457-61.

BackgroundEpidural analgesia is associated with an increased rate of fever in prospective randomized trials. While the evidence suggests that epidural fever is not infectious, epidural analgesia has been associated with increased rates of antibiotic use, the indications that prompt treatment have not been examined.MethodsWe analyzed 1235 nulliparous women with singleton term pregnancies presenting in labor with a temperature of < 99.5 degrees F. Antibiotic use during labor was categorized by indication.ResultsA total of 59.6% of women received epidural analgesia. The rate of antibiotic use was significantly higher in women receiving epidural analgesia (28 vs 10.8%). After adjusting for confounders using logistic regression, epidural analgesia was associated with a relative risk of 2.6 (95% CI 2.0, 3.4) for antibiotic treatment. The majority of the increased risk was due to significantly higher rates of antibiotic treatment for presumed chorioamnionitis (9.0 vs 0.4%) in the epidural analgesia group.ConclusionEpidural-related fever results in excess maternal antibiotic treatment for presumed chorioamnionitis.

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