The Effect of patient warming during Caesarean delivery on maternal and neonatal outcomes: a meta-analysis

Sultan, P.; Habib, A.S.; Cho, Y.; Carvalho, B.

doi:10.1093/bja/aev325

Cited by 108Thermal Regulation in MedicineMaternal and Perinatal Health InterventionsAnesthesia and Pain Management

The Effect of patient warming during Caesarean delivery on maternal and neonatal outcomes: a meta-analysis

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Sultan, P., Habib, A.S., Cho, Y., Carvalho, B.·2015·British Journal of Anaesthesia

DOI 10.1093/bja/aev325PMC PMC4574493

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Abstract

Background Perioperative warming is recommended for surgery under anaesthesia, however its role during Caesarean delivery remains unclear. This meta-analysis aimed to determine the efficacy of active warming on outcomes after elective Caesarean delivery. Methods We searched databases for randomized controlled trials utilizing forced air warming or warmed fluid within 30 min of neuraxial anaesthesia placement. Primary outcome was maximum temperature change. Secondary outcomes included maternal (end of surgery temperature, shivering, thermal comfort, hypothermia) and neonatal (temperature, umbilical cord pH and Apgar scores) outcomes. Standardized mean difference/mean difference/risk ratio (SMD/MD/RR) and 95% confidence interval (CI) were calculated using random effects modelling (CMA, version 2, 2005). Results 13 studies met our criteria and 789 patients (416 warmed and 373 controls) were analysed for the primary outcome. Warming reduced temperature change (SMD -1.27°C [-1.86, -0.69]; P=0.00002); resulted in higher end of surgery temperatures (MD 0.43 °C [0.27, 0.59]; P<0.00001); was associated with less shivering (RR 0.58 [0.43, 0.79]; P=0.0004); improved thermal comfort (SMD 0.90 [0.36, 1.45]; P=0.001), and decreased hypothermia (RR 0.66 [0.50, 0.87]; P=0.003). Umbilical artery pH was higher in the warmed group (MD 0.02 [0, 0.05]; P=0.04). Egger's test (P=0.001) and contour-enhanced funnel plot suggest a risk of publication bias for the primary outcome of temperature change. Conclusions Active warming for elective Caesarean delivery decreases perioperative temperature reduction and the incidence of hypothermia and shivering. These findings suggest that forced air warming or warmed fluid should be used for elective Caesarean delivery.

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Active steps to maintain normothermia are supported by high-quality evidence.
“Active steps to maintain normothermia are supported by highquality evidence.19”
From Society for Maternal-Fetal Medicine Special Statement: Surgical safety checklists for cesarean delivery (2021) · cites this paper as [19]
The Discussion recommends active warming for elective Caesarean delivery to reduce maternal temperature decreases, hypothermia, and shivering (page not available in our copy). It does not characterize the evidence as high-quality; it notes significant heterogeneity and possible publication bias. The claim also omits the elective-Caesarean-delivery setting to which the recommendation applies. (LLM, conf=0.87)
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Improving intraoperative temperature management in elective repeat cesarean deliveries: a retrospective observational cohort study
Hoefnagel, A. L., Vanderhoef, K., Anwar, A., Damalanka, V. S. L., Shah, S. J., Diachun, C. A. B., & Mongan, P. D. (2020) · Patient Safety in Surgery · doi:10.1186/s13037-020-00241-x · Cited by 11 · see citing works

Authors: Sultan, P., Habib, A. S., Cho, Y., & Carvalho, B.
Affiliations: University College Hospital (GB)
Duke University (US)
Stanford Medicine (US)
Corresponding author: Sultan, P.
ORCID: Sultan, P.
Habib, A.S.
Carvalho, B.
Venue: British Journal of Anaesthesia
Publisher: Elsevier BV
Published: 2015-10
Volume: 115
Issue: 4
Pages: 500-510
ISSN: 0007-0912 (ISSN-L)
DOI: 10.1093/bja/aev325
PMC: PMC4574493
OpenAlex: W2247729138
Cited by: 108
References: 61
Citations by year: 2026: 10 · 2025: 6 · 2024: 11 · 2023: 7 · 2022: 10 · 2021: 18 · 2020: 7 · 2019: 11 · 2018: 7 · 2017: 14 · 2016: 7
FWCI: 1.34
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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www.elsevier.com/open-access/userlicense/1.0/ (vor, 795 d)
Locations: British Journal of Anaesthesia (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Thermal Regulation in Medicine
Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Keywords: patient warming, cesarean section, perioperative hypothermia, shivering, thermal comfort, forced-air warming, warmed intravenous fluids, neuraxial anesthesia, umbilical cord pH, neonatal outcomes, maternal outcomes
MeSH terms: Body Temperature, Cesarean Section, Female, Hot Temperature, Humans, Hypothermia, Pregnancy, Shivering, Rewarming, Perioperative Care

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The Effect of patient warming during Caesarean delivery on maternal and neonatal outcomes: a meta-analysis

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