Construction of risk factors model and prevention strategy of intrapartum fever associated labor analgesia by combined spinal and epidural anesthesia

Objective To establish a risk factor model of labor fever associated labor analgesia by combined spinal and epidural anesthesia, and to propose targeted prevention strategies.

Methods A retrospective analysis was performed for 202 cases of parturience analgesia in combination with combined spinal and epidural anesthesia. According to whether the fever occurred during childbirth (peak maternal oral body temperature ≥38 ℃) or not, the patients were divided into fever during childbirth group (32 cases) and without fever during childbirth group (170 cases). The general data of the two groups were compared; the multiple Logistic regression analysis was used to analyze the risk factors of parturient fever in parturient parturient analgesic labor; the Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model; the receiver operating characteristic (ROC) curve was drawn to evaluate the prediction effect of the model.

Results There were statistically significant differences in cervical maturation promotion, amniotic fluid contamination, labor analgesia time, labor time, prenatal white blood cell (WBC) count and prenatal C-reactive protein (CRP) level between the two groups (P < 0.05). Logistic regression analysis showed that the use of balloon for cervical maturation, amniotic fluid contamination, labor time >9 h, labor analgesia time >5 h, prenatal WBC >10×10⁹/L, prenatal CRP level >10 mg/L were risk factors for labor fever associated with lumbo-hard labor analgesia (P < 0.05). Hosmer-Lemeshow test showed that the model had a good goodness of fit; ROC curve was drawn according to the predicted value and the true value, and the area under the curve (AUC) was 0.869 (95%CI, 0.815 to 0.912), indicating good predictive value of the model. When the optimal cut-off value was >13.2, the sensitivity was 78.12%, the specificity was 85.29%, and the significance P value was less than 0.001, indicating that the model had good predictive value.

Conclusion The use of balloon to promote cervical maturation, amniotic fluid contamination, labor analgesia time >5 h, labor time >9 h, prenatal WBC >10×10⁹/L, prenatal CRP level >10 mg/L are the risk factors of labor fever associated with lumbar and epidural labor analgesia, which deserves clinical attention.