Abstract
Background Epidural analgesia is associated with a fourfold increased rate of intrapartum fever.
The likely pathophysiology is a noninfectious maternal inflammatory activation. Safe
interventions to reduce maternal and neonatal exposures to intrapartum fever and inflammation
are needed.
Objective The purpose of this study was to determine if prophylactic epidural steroids decrease
fetal exposure to hyperthermia and inflammatory cytokines following epidural analgesia.
Study Design This is a randomized, double-blinded, placebo controlled trial. Term nulliparous
women requesting epidural analgesia received 80 mg methylprednisolone or preservative-free
normal saline via the epidural catheter at placement. The primary outcome was maternal
temperature >100.4°F. Secondary outcomes included fetal exposure to inflammation as
assessed by cord blood interleukin-6 (IL-6) levels and rates of funisitis. Power analysis
estimated a sample size requirement of 276, but new Food and Drug Administration (FDA)
recommendations advising a black box warning on epidural steroids resulted in early
study termination.
Results A total of 116 subjects were enrolled: 58 treatments and 58 placebos. There was no
difference in the rate of maternal intrapartum fever or cord blood IL-6 levels between
treatment arms. No complications listed in the FDA warning occurred.
Conclusion Prophylactic epidural methylprednisolone was not effective in reducing intrapartum
fever or neonatal inflammation following epidural analgesia. Alternate mechanisms
and preventative strategies should be considered.
Keywords
epidural analgesia - maternal fever - chorioamnionitis - inflammation - steroids -
labor - funisitis
