The Impact of Intrapartum Fever During Combined Spinal-Epidural Analgesia on Maternal and Neonatal Outcomes

Background: Epidural analgesia is recognized as the gold standard for labor analgesia; however, its associated complication—epidural-related maternal fever (ERMF)—has become a focus of clinical concern. ERMF not only increases maternal infectious evaluations and antibiotic use but may also adversely affect neonatal outcomes. Combined spinal-epidural analgesia (CSEA), with its rapid onset and reduced requirement for local anesthetics, is considered to potentially reduce the risk of ERMF. Objective: This study aimed to investigate the impact of ERMF on maternal and neonatal outcomes among parturients receiving CSEA for labor analgesia. Methods: This retrospective study included 100 full-term primiparas who delivered at the Zhaoqing Branch of the Third Affiliated Hospital of Sun Yat-sen University between January and June 2025, all of whom received CSEA for labor analgesia. Based on whether fever occurred during labor (axillary temperature ≥37.5 ℃), participants were categorized into a fever group (n=50) and an afebrile group (n=50). Maternal demographic data, labor parameters, laboratory indices, and neonatal outcomes were collected and compared between groups. Results: Compared with the afebrile group, the fever group had a significantly prolonged second stage of labor (P<0.05), increased intrapartum blood loss, and higher oxytocin usage (P<0.05). Postpartum leukocyte counts and neutrophil ratios were elevated in the fever group (P<0.05), whereas no significant differences were observed at admission. Regarding neonatal outcomes, no significant differences were found in birth weight, length, or Apgar scores (P>0.05); however, the fever group demonstrated higher umbilical arterial lactate levels, lower base excess (P<0.05), and a significantly increased NICU admission rate (P<0.05). Conclusions: ERMF is not uncommon among parturients receiving CSEA for labor analgesia. Its occurrence may contribute to prolonged second-stage labor, increased maternal blood loss, greater oxytocin requirement, and unfavorable short-term neonatal outcomes. Clinicians should strengthen the prevention and management of ERMF while ensuring adequate analgesia to optimize maternal and neonatal outcomes.