Neuraxial labour analgesia and maternal fever

Neuraxial labour analgesia is considered the 'gold-standard' technique for the provision of analgesia during vaginal birth. Recently, there has been growing interest in the potential impacts of labour epidural analgesia beyond pain relief. One particular concern is its association with the development of maternal fever, so-called epidural-related maternal fever (ERMF). Hyperthermia during labour is a significant clinical concern, as it can impact both maternal and neonatal outcomes. This narrative review explores the association between epidural analgesia and maternal fever, outlines its suggested pathophysiological mechanisms, examines its potential implications and considers the management of neuraxial analgesia in the context of existing maternal fever. The two main theories explaining the development of ERMF are the sterile inflammation hypothesis, and the altered thermoregulation hypothesis. Patient characteristics, features of pregnancy and labour, midwifery and/or obstetric interventions and epidural-related factors can all contribute to an increased risk of developing ERMF. Although these factors may be manipulated to reduce ERMF incidence, there is no clear evidence that supports the recommendation of any intervention to prevent ERMF development. The associated detrimental effects of maternal fever on the woman, foetus, and newborn are highlighted, although many of these adverse outcomes have not been definitively established when ERMF has been the focus of study. There remains a significant need to further understand the pathophysiology, clinical significance, preventive strategies and treatment modalities of ERMF. It is crucial that future studies distinguish ERMF as a distinct category within maternal intrapartum fever.