Maternal Epidural Steroids and Hyperthemia

The association between epidural analgesia and increased maternal intrapartum temperature has
been well documented in multiple randomized controlled trials. The exact mechanism for this
elevation in temperature is unknown; however the most likely cause appears to be
non-infectious inflammatory stimulation. Fetal exposure to maternal fever in utero has been
linked with increased antibiotic treatment, increased neonatal sepsis evaluation, and longer
length of stay for neonates. In addition there is evidence to suggest intrapartum fevers may
lower the threshold for fetal hypoxic brain injury and increase the risk of cerebral palsy.
The risk of neonatal encephalopathy in infants born to febrile mothers is 1% compared to 0.1%
to afebrile mothers. Safe interventions are needed to prevent adverse fetal outcomes.

Inclusion criteria:

- Nulliparity

- Age>=18

- Patient requests epidural analgesia

- GA >= 37 weeks

Exclusion criteria:

- No prenatal care

- Temperature >99.4 at decision for epidural placement

- Cervical dilation >4cm

- Diabetes (pre-gestational or gestational)

- Autoimmune condition

- Pre-eclampsia

- Maternal heart disease

- Current steroid use

- Active infection (bacterial or viral)

- Wet Tap (CSF on placement of epidural)

- Pre-gestational diabetes

- Known systemic infection (bacterial, viral, fungal or tubercular)

- Known allergy to steroids

- Heart failure

- Hypertensive crisis

- History of active epilepsy