Low A pgar score, neonatal encephalopathy and epidural analgesia during labour: a S wedish registry‐based study

TÖRNELL, S.; EKÉUS, C.; HULTIN, M.; HÅKANSSON, S.; THUNBERG, J.; HÖGBERG, U.

doi:10.1111/aas.12477

Cited by 60Anesthesia and Pain ManagementMaternal and Perinatal Health InterventionsNeonatal and fetal brain pathology

Low A pgar score, neonatal encephalopathy and epidural analgesia during labour: a S wedish registry‐based study

TÖRNELL, S., EKÉUS, C., HULTIN, M., HÅKANSSON, S., THUNBERG, J., HÖGBERG, U.·2015·Acta Anaesthesiologica Scandinavica

DOI 10.1111/aas.12477

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Abstract

Background: Maternal intrapartum fever (MF) is associated with neonatal sequelae, and women in labour who receive epidural analgesia (EA) are more likely to develop hyperthermia. The aims of this study were to investigate if EA and/or a diagnosis of MF were associated to adverse neonatal outcomes at a population level. Methods: Population‐based register study with data from the S wedish B irth R egister and the S wedish N ational P atient R egister, including all nulliparae (n = 294,329) with singleton pregnancies who gave birth at term in S weden 1999–2008. Neonatal outcomes analysed were A pgar score (AS) < 7 at 5 min and ICD‐10 diagnosis of neonatal encephalopathy (e.g. convulsions or neonatal cerebral ischaemia). Multivariate logistic regression was used to calculate adjusted odds ratios (AOR) with 95% confidence intervals (CI). Results: EA was used in 44% of the deliveries. Low AS or encephalopathy was found in 1.26% and 0.39% of the children in the EA group compared with 0.80% and 0.29% in the control group. In multivariate analysis, EA was associated with increased risk with low AS, AOR 1.27 (95% CI 1.16–1.39), but not with diagnosis of encephalopathy, 1.11 (0.96–1.29). A diagnosis of MF was associated with increased risk for both low AS, 2.27 (1.71–3.02), and of neonatal encephalopathy, 1.97 (1.19–3.26). Conclusion: Diagnosis of MF was associated with low AS and neonatal encephalopathy, whereas EA was only associated with low AS and not with neonatal encephalopathy. The found associations might be a result of confounding by indication, which is difficult to assess in a registry‐based population study.

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The higher 1-minute Apgar scores in newborns of mothers participating in MBCP could result from less intrapartum EA use in MBCP (39%) compared with ECAU (59%) participants.
“The higher 1‐minute Apgar scores in newborns of mothers participating in MBCP could result from less intrapartum EA use 10 , 14 in MBCP (39%) compared with ECAU (59%) participants.”
From Fear of childbirth, nonurgent obstetric interventions, and newborn outcomes: A randomized controlled trial comparing mindfulness‐based childbirth and parenting with enhanced care as usual. (2022) · cites this paper as [10]

External review and validation of the Swedish national inpatient register
Ludvigsson, J. F., Andersson, E., Ekbom, A., Feychting, M., Kim, J.-L., Reuterwall, C., Heurgren, M., & Olausson, P. O. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-450 · Cited by 5,055 · see citing works
Intrauterine growth curves based on ultrasonically estimated foetal weights
Maršál, K., Persson, P., Larsen, T., Lilja, H., Selbing, A., & Sultan, B. (1996) · Acta paediatrica · doi:10.1111/j.1651-2227.1996.tb14164.x · Cited by 1,900 · see citing works
Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study
Badawi, N. A., Kurinczuk, J. J., Keogh, J., Alessandri, L. M., O'Sullivan, F., Burton, P. R., Pemberton, P. J., & Stanley, F. J. (1998) · BMJ · doi:10.1136/bmj.317.7172.1549 · Cited by 891 · see citing works
Epidural versus non-epidural or no analgesia in labour
Anim-Somuah, M., Smyth, R. M., & Jones, L. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000331.pub3 · Cited by 855 · see citing works
Maternal Infection and Cerebral Palsy in Infants of Normal Birth Weight
Grether, J. K. (1997) · JAMA · doi:10.1001/jama.1997.03550030047032 · Cited by 821 · see citing works
Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study
Badawi, N. A., Kurinczuk, J. J., Keogh, J., Alessandri, L. M., O'Sullivan, F., Burton, P. R., Pemberton, P. J., & Stanley, F. J. (1998) · BMJ · doi:10.1136/bmj.317.7172.1554 · Cited by 586 · see citing works
FATAL BENZYL ALCOHOL POISONING IN A NEONATAL INTENSIVE CARE UNIT
Brown, W., Buist, N. M., Gipson, H. C., Huston, R. K., & Kennaway, N. G. (1982) · The Lancet · doi:10.1016/s0140-6736(82)92377-7 · Cited by 397 · see citing works
Effects of normothermic versus mild hyperthermic forebrain ischemia in rats.
Dietrich, W. D., Busto, R., Valdés, I., & Loor, Y. (1990) · Stroke · doi:10.1161/01.str.21.9.1318 · Cited by 321 · see citing works
Intrapartum Maternal Fever and Neonatal Outcome
Lieberman, E., Lang, J. M., Richardson, D. K., Frigoletto, F. D., Heffner, L. J., & Cohen, A. (2000) · PEDIATRICS · doi:10.1542/peds.105.1.8 · Cited by 259 · see citing works
MATERNAL PYREXIA ASSOCIATED WITH THE USE OF EPIDURAL ANALGESIA IN LABOUR
Fusi, L., Maresh, M., Steer, P., & Beard, R. W. (1989) · The Lancet · doi:10.1016/s0140-6736(89)92341-6 · Cited by 254 · see citing works
Temperature Changes of greater or equal to 1 degree Celsius Alter Functional Neurologic Outcome and Histopathology in a Canine Model of Complete Cerebral Ischemia
Wass, C. T., Lanier, W. L., Hofer, R. E., Scheithauer, B. W., & Andrews, A. G. (1995) · Anesthesiology · doi:10.1097/00000542-199508000-00013 · Cited by 243 · see citing works
Sevoflurane and Halothane Reduce Focal Ischemic Brain Damage in the Rat
Warner, D. S., McFarlane, C., Todd, M. M., Ludwig, P., & McAllister, A. (1993) · Anesthesiology · doi:10.1097/00000542-199311000-00017 · Cited by 192 · see citing works
Intrapartum Temperature Elevation, Epidural Use, and Adverse Outcome in Term Infants
Greenwell, E., Wyshak, G., Ringer, S. A., Johnson, L. C., Rivkin, M. J., & Lieberman, E. (2012) · PEDIATRICS · doi:10.1542/peds.2010-2301 · Cited by 179 · see citing works
Fever in labour and neonatal encephalopathy: a prospective cohort study
Impey, L. W. M., Greenwood, C. E. L., MacQuillan, K., Reynolds, M. A., & Sheil, O. (2001) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2001.00145.x · Cited by 163 · see citing works
Labor Epidural Analgesia and Maternal Fever
Segal, S. (2010) · Anesthesia & Analgesia · doi:10.1213/ane.0b013e3181f713d4 · Cited by 161 · see citing works
The Duration of Labor in Healthy Women
Albers, L. L., & for the CNM Data Group 1996a (1999) · Journal of Perinatology · doi:10.1038/sj.jp.7200100 · Cited by 161 · see citing works
MATERNAL TEMPERATURE REGULATION DURING EXTRADURAL ANALGESIA FOR LABOUR
Camann, W., HORTVET, L. A., HUGHES, N., Bader, A. M., & DATTA, S. (1991) · British Journal of Anaesthesia · doi:10.1093/bja/67.5.565 · Cited by 156 · see citing works
Association of maternal fever during labor with neonatal and infant morbidity and mortality
Петрова, А. (2001) · Obstetrics and Gynecology · doi:10.1016/s0029-7844(01)01361-8 · Cited by 149 · see citing works
Elevated maternal and fetal serum interleukin-6 levels are associated with epidural fever
Goetzl, L. M., Evans, T., Rivers, J. M., Suresh, S., & Lieberman, E. (2002) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2002.127135 · Cited by 144 · see citing works
Intrapartum Epidural Analgesia and Maternal Temperature Regulation
Goetzl, L. M., Rivers, J. M., Zighelboim, I., Wali, A., Badell, M. L., & Suresh, S. (2007) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000255976.14297.f6 · Cited by 125 · see citing works
Epidural analgesia and intrapartum fever: placental findings
Dashe, J. S. (1999) · Obstetrics and Gynecology · doi:10.1016/s0029-7844(98)00415-3 · Cited by 112 · see citing works
The effects of maternal labour analgesia on the fetus
Reynolds, F. (2009) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2009.11.003 · Cited by 110 · see citing works
Deliveries, mothers and newborn infants in Sweden, 1973–2000
Odlind, V., Haglund, B., Pakkanen, M., & Olausson, P. O. (2003) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1034/j.1600-0412.2003.00112.x · Cited by 110 · see citing works
Risk factors for fever in labor
Herbst, A., Wölner‐Hanssen, P., & Ingemarsson, I. (1995) · Obstetrics and Gynecology · doi:10.1016/0029-7844(95)00254-o · Cited by 108 · see citing works
Maternal Temperature Monitoring During Labor: Concordance and Variability Among Monitoring Sites
Banerjee, S., Cashman, P., Yentis, S. M., & Steer, P. J. (2004) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000100155.85379.88 · Cited by 91 · see citing works
Lumbar Epidural Analgesia in Labour
Thalme, B., Belfrage, P., & Raabe, N. K. (1974) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.3109/00016347409156885 · Cited by 89 · see citing works
Association between epidural analgesia during labor and fever.
Vinson, D. C., Thomas, R., & Kiser, T. (1993) · PubMed · Cited by 78 · see citing works
Epidural analgesia in labor and fetal hyperthermia.
Camann, W. (1993) · PubMed · Cited by 71 · see citing works
Epidural analgesis in labor and fetal hyperthermia
Macaulay, J. H., Bond, K., & Steer, P. (1993) · International Journal of Gynecology & Obstetrics · doi:10.1016/0020-7292(93)90760-t · Cited by 60 · see citing works
COMPUTER ANALYSIS OF LABOUR PROGRESSION
Friedman, E. A., & Kroll, B. H. (1969) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1969.tb05788.x · Cited by 56 · see citing works
Continuous monitoring of fetal temperature by noninvasive probe and its relationship to maternal temperature, fetal heart rate, and cord arterial oxygen and pH
Macaulay, J. H., Randall, N., Bond, K., & Steer, P. J. (1992) · Obstetrics and Gynecology · doi:10.1097/00006250-199203000-00029 · Cited by 49 · see citing works
THE EFFECT OF CONTINUOUS LUMBAR EPIDURAL ANALGESIA ON MATERNAL ACID‐BASE BALANCE AND ARTERIAL LACTATE CONCENTRATION DURING THE SECOND STAGE OF LABOUR
Pearson, J. F., & Davies, P. (1973) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1973.tb02189.x · Cited by 48 · see citing works
The incidence of maternal fever during labor is less with intermittent than with continuous epidural analgesia: a randomized controlled trial
Mantha, V., Vallejo, M. C., Ramesh, V., Phelps, A. L., & Ramanathan, S. (2008) · International Journal of Obstetric Anesthesia · doi:10.1016/j.ijoa.2007.07.006 · Cited by 45 · see citing works
Chorioamnionitis, not epidural analgesia, is associated with maternal fever during labour
Vallejo, M. C., Kaul, B., Adler, L. J., Phelps, A. L., Craven, C., MACPHERSON, T. A., Sweet, R. L., & Ramanathan, S. (2001) · Canadian Journal of Anesthesia/Journal canadien d anesthésie · doi:10.1007/bf03020380 · Cited by 42 · see citing works
Association Between Epidural Analgesia During Labor and Fever
Vinson, D. C., Thomas, R., & Kiser, T. (1994) · Obstetrical & Gynecological Survey · doi:10.1097/00006254-199401000-00008 · Cited by 39 · see citing works
What Factors Affect Intrapartum Maternal Temperature? A Prospective Cohort Study
Frölich, M. A., Esame, A., Zhang, K., Wu, J., & Owen, J. (2012) · Anesthesiology · doi:10.1097/aln.0b013e31825a30ef · Cited by 38 · see citing works
Low Dose Intermittent Epidural Anaesthesia with Lidocaine for Vaginal Delivery II
Zador, G., & Nilsson, B. A. (1974) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.3109/00016347409156393 · Cited by 35 · see citing works
Labor epidural analgesia is independent risk factor for neonatal pyrexia
Agakidis, C., Agakidou, E., Thomas, S., Murthy, P., & Lloyd, D. J. (2011) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.3109/14767058.2010.545923 · Cited by 30 · see citing works
The effect of epidural analgesia on material thermoregulation in labor
Kapusta, L., Confino, E., Ismajovich, B., Rosenblum, Y., & David, M. P. (1985) · International Journal of Gynecology & Obstetrics · doi:10.1016/0020-7292(85)90102-x · Cited by 30 · see citing works
The need for epidural analgesia is related to birthweight – a population‐based register study
Ekéus, C., Hjern, A., & Hjelmstedt, A. (2009) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1080/00016340902763236 · Cited by 24 · see citing works
Self-citation
Computer analysis of labor progression. 3. Pattern variations by parity.
Ea, F., & Bh, K. (1971) · PubMed · Cited by 19 · see citing works
Association Between Epidural Analgesia During Labor and Fever
VINSON, D. C., Thomas, R., & RISER, T. (1994) · Survey of Anesthesiology · doi:10.1097/00132586-199402000-00029 · Cited by 16 · see citing works
A new device for measuring intrauterine temperature
SCISCIONE, A. C., Zainia, T., Leet, T. L., Winn, J. N., & Winn, H. N. (2001) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2001.115046 · Cited by 11 · see citing works
Regional anaesthesia and uterine blood flow.
Hollmén, A. I., Jouppila, R., & Jouppila, P. (1984) · PubMed · Cited by 11 · see citing works

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Seijmonsbergen‐Schermers, A. E., van den Akker, T., Rydahl, E., Beeckman, K., Bogaerts, A., Binfa, L., Frith, L., Groß, M. M., Misselwitz, B., Hálfdánsdóttir, B., et al. (2020) · PLoS Medicine · doi:10.1371/journal.pmed.1003103 · Cited by 213 · see citing works
Management of clinical chorioamnionitis: an evidence-based approach
Conde‐Agudelo, A., Romero, R. J., Jung, E., & Sánchez, Á. J. G. (2020) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2020.09.044 · Cited by 128 · see citing works
Epidural analgesia in labor: A narrative review
Halliday, L., Nelson, S. M., & Kearns, R. J. (2022) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.14175 · Cited by 125 · see citing works
Epidural-Related Fever and Maternal and Neonatal Morbidity: A Systematic Review and Meta-Analysis
Jansen, S. J., Lopriore, E., Naaktgeboren, C. A., Sueters, M., Limpens, J., van Leeuwen, E., & Bekker, V. (2020) · Neonatology · doi:10.1159/000504805 · Cited by 72 · see citing works
Epidural-related maternal fever: incidence, pathophysiology, outcomes, and management
Patel, S. D., Ciechanowicz, S., Blumenfeld, Y. J., & Sultan, P. (2023) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2022.06.026 · Cited by 75 · see citing works
Epidural analgesia, intrapartum hyperthermia, and neonatal brain injury: a systematic review and meta-analysis
Morton, S., Kua, J., & Mullington, C. J. (2020) · British Journal of Anaesthesia · doi:10.1016/j.bja.2020.09.046 · Cited by 63 · see citing works
Association of Epidural Analgesia in Women in Labor With Neonatal and Childhood Outcomes in a Population Cohort
Kearns, R. J., Shaw, M., Gromski, P. S., Iliodromiti, S., Lawlor, D. A., & Nelson, S. M. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.31683 · Cited by 55 · see citing works
Epidural Labor Analgesia and Maternal Fever
Sharpe, E. E., & Arendt, K. W. (2017) · Clinical Obstetrics & Gynecology · doi:10.1097/grf.0000000000000270 · Cited by 51 · see citing works
Differences in maternal temperature during labour with remifentanil patient-controlled analgesia or epidural analgesia: a randomised controlled trial
Douma, M. R., Stienstra, R., Middeldorp, J. M., Arbous, M. S., & Dahan, A. (2015) · International Journal of Obstetric Anesthesia · doi:10.1016/j.ijoa.2015.06.003 · Cited by 47 · see citing works
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Intrapartum epidural analgesia and low Apgar score among singleton infants born at term: A propensity score matched study
Ravelli, A. C. J., Eskes, M., de Groot, C. J. M., Abu‐Hanna, A., & van der Post, J. A. M. (2020) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13837 · Cited by 29 · see citing works
Risk Factors and Safety Analyses for Intrapartum Fever in Pregnant Women Receiving Epidural Analgesia During Labor
Ren, J., Wang, T., Yang, B., Jiang, L., Xu, L., Geng, X., & Liu, Q. (2021) · Medical Science Monitor · doi:10.12659/msm.929283 · Cited by 28 · see citing works
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Obstetric analgesia in labor and its association with neonatal outcomes
Silva, Y. A. P., Araújo, F. G., Amorim, T., Martins, E. F., & Felisbino-Mendes, M. S. (2020) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2018-0757 · Cited by 22 · see citing works
Does epidural anesthesia influence pelvic floor muscle endurance and strength and the prevalence of urinary incontinence 6 weeks postpartum?
Wáng, Q., Yu, X., Sun, X., & Wang, J. (2019) · International Urogynecology Journal · doi:10.1007/s00192-019-04176-5 · Cited by 22 · see citing works
Effects of Labor Epidural Analgesia on Short Term Neonatal Morbidity
Salameh, K., Vellamgot, A. P., Abedin, S., Hussain, H. L., Salim, S. T., & Mahmoud, A. S. (2020) · International Journal of Women s Health · doi:10.2147/ijwh.s228738 · Cited by 22 · see citing works
Neuraxial analgesia in labour and the foetus
Kearns, R. J., & Lucas, D. N. (2023) · Best Practice & Research Clinical Anaesthesiology · doi:10.1016/j.bpa.2023.02.005 · Cited by 21 · see citing works
Relationship between delivery with anesthesia and postpartum depression: The Japan Environment and Children’s Study (JECS)
Suzumori, N., Ebara, T., Tamada, H., Matsuki, T., Sato, H., Kato, S., Saitoh, S., Kamijima, M., Sugiura‐Ogasawara, M., the Japan Environment, C. S. G., et al. (2021) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-021-03996-y · Cited by 18 · see citing works
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Hess, P. E. (2017) · International Journal of Obstetric Anesthesia · doi:10.1016/j.ijoa.2017.03.008 · Cited by 6 · see citing works
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Douma, M. R., Stienstra, R., Middeldorp, J. M., Arbous, M. S., & Dahan, A. (2016) · Obstetric Anesthesia Digest · doi:10.1097/01.aoa.0000489486.50219.0f · Cited by 6 · see citing works
Labor epidural analgesia and autism spectrum disorder in 3-year-old offspring based on data from the Japan Environment and Children’s Study: a prospective cohort study
Fukuda, T., Kyozuka, H., Murata, T., Yasuda, S., Yamaguchi, A., Satô, A., Ogata, Y., Go, H., Hosoya, M., Yasumura, S., et al. (2025) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2025.2509147 · Cited by 5 · see citing works
Postpartum complications following neuraxial anaesthesia for obstetric physicians
Lawrence, H., & Morton, A. (2022) · Obstetric Medicine · doi:10.1177/1753495x221146329 · Cited by 5 · see citing works
Does the presence of epidural analgesia reduce the risk of neonatal sepsis in the setting of an intrapartum fever?
Ward, C., & Caughey, A. B. (2020) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2020.1779694 · Cited by 4 · see citing works
Therapeutic hypothermia for neonatal encephalopathy with sepsis: a retrospective cohort study
Sibbin, K., Crawford, T. M., Stark, M. J., & BATTIN, M. R. (2022) · BMJ Paediatrics Open · doi:10.1136/bmjpo-2022-001420 · Cited by 3 · see citing works
Predictive models for intrapartum maternal fever: Development and validation of pre-analgesia and labor process indicators
Liu, B., Liang, L., Wei, D., Li, Y., Jia, F., Li, H., Li, N., Xiao, H., & Zhang, J. (2025) · Medicine · doi:10.1097/md.0000000000042939 · Cited by 2 · see citing works
Relatively low plasma cortisol levels in parturients are associated with epidural-related maternal fever
Zhang, C., Chu, Q., Wang, T., Bing, H., Bai, L., Sun, L., Zhang, D., Wang, J., Li, L., Zhou, Q., et al. (2025) · Annals of Medicine · doi:10.1080/07853890.2025.2534086 · Cited by 2 · see citing works
Cooling treatment on the reduction of category II fetal tracings
Zhao, B., Li, B., Wang, Q., Song, X., & Jia, J. (2024) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2023.2299567 · Cited by 1 · see citing works
Effects of epidural analgesia in infants born from low-risk pregnancies
Dani, C., Giannetti, D., Bitossi, U., Micaglio, M., Toscano, F., Zullino, S., Pasquini, L., & Poggi, C. (2025) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2025.114835 · Cited by 1 · see citing works
Multicenter validation of a machine learning model for predicting intrapartum high fever in parturients receiving labor analgesia
Liu, B., Ling, L., Li, C., Dou, S., Zhang, J., & Jia, F. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1827290 · Cited by 1 · see citing works
Is Epidural Analgesia a Predictor of Low Newborn Apgar? A Hospital-Based Observational Study
Duarte, A. S. S., & Figueira, F. L. H. (2015) · Journal of Anesthesia & Clinical Research · doi:10.4172/2155-6148.1000565 · Cited by 1 · see citing works
Low Apgar Score, Neonatal Encephalopathy, and Epidural Analgesia During Labor
Törnell, S. S., Ekéus, C., Hultin, M., Håkansson, S., Thunberg, J., & Högberg, U. (2016) · Obstetric Anesthesia Digest · doi:10.1097/01.aoa.0000479494.36258.d1 · Cited by 1 · see citing works
Self-citation
Bolos epidurales intermitentes programados para mantenimiento de la analgesia del trabajo de parto: Estudio observacional, analítico de tipo cohorte
Lozano, M. L. C., Moreno-Gonzales, R., Pinedo, D. J. S., Vásquez-Rojas, G., & Velasquez, A. A. (2020) · Revista Peruana de Investigación Materno Perinatal · doi:10.33421/inmp.2020194 · Cited by 1 · see citing works
Implementing AWHONN’s Evidence Based Guidelines for Managing the Second Stage of Labor
Knapp, G. (2017) · doi:10.22371/07.2017.027 · Cited by 1 · see citing works
OB/GYN anesthesia: Finding the best and safest arrows in the quiver
Vuilleumier, P. H. (2018) · Trends in Anaesthesia and Critical Care · doi:10.1016/j.tacc.2018.05.005
Current Resources for Evidence‐Based Practice, May/June 2021
Barger, M. K. (2021) · Journal of Midwifery & Women s Health · doi:10.1111/jmwh.13257
Development and validation of a predictive model for intrapartum fever using indicators measured before the start of labor analgesiaPreprint
Liu, B., Liang, L., Jia, F., Wei, D., Li, Y., Li, H., Xiao, H., Wang, M., Zhang, G., Zhang, J., et al. (2024) · Research Square · doi:10.21203/rs.3.rs-4784835/v1
Additional file 2 of Suspected clinical chorioamnionitis with peak intrapartum temperature <380C: the prevalence of confirmed chorioamnionitis and short term neonatal outcome
Vellamgot, A. P., Salameh, K., Habboub, L., Pattuvalappil, R., Elkabir, N. A., Siam, Y. S., & Khatib, H. (2022) · Figshare · doi:10.6084/m9.figshare.19582357
Sensory Block Height and Risk of Maternal Fever in Epidural Labour Analgesia: A Prospective Cohort Study
Tian, L., Wei, X., Cao, R., Tang, Y., Liang, L., Jia, F., Yang, L., Li, N., Jing, X., Wang, Y., et al. (2026) · Journal of Pain Research · doi:10.2147/jpr.s565186
Development and validation of a multivariable logistic regression model for predicting epidural‐related maternal fever during labor analgesia: A retrospective cohort study
Ma, J., Lu, P., Sun, M., & Cheng, J. (2026) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.70963
Effect of Epidural Analgesia During Low-Risk Labor and Delivery on Cerebral Oximetry in Term Neonates Measured by Near-Infrared Spectroscopy: A Pilot Study
de Paz, M. T. G.-R. T., Sánchez, A. G., Vargas-Chiarella, C. R., Sastre, J. A., de Viñaspre‐Hernández, R. R., Navas-Echazarreta, N., & Garzón-Sánchez, J. C. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15093404
Epidural-related maternal fever
Bilen, H., & Lange, E. M. S. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-21917-7.00028-8
Impact of Epidural-Related Maternal Fever on Neonatal Outcomes: A Single-Center Retrospective Case–Control Study Excluding Confirmed Histological Chorioamnionitis
Yamazaki, Y., Hyuga, S., Isohata, H., Goto, H., Yoshimura, Y., Hattori, K., Shimaoka, T., Kondo, H., Fujita, T., Oikawa, J., et al. (2026) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000008176
Epidural‐Related Maternal Fever Is Associated With Structural Alterations in Vaginal Floral Homeostasis Among Parturients
Xiong, C., Chen, X., Zhai, W., & Zhang, X. (2026) · Obstetrics and Gynecology International · doi:10.1155/ogi/7458179

Low Apgar Score, Neonatal Encephalopathy, and Epidural Analgesia During Labor
Törnell, S. S., Ekéus, C., Hultin, M., Håkansson, S., Thunberg, J., & Högberg, U. (2016) · Obstetric Anesthesia Digest · doi:10.1097/01.aoa.0000479494.36258.d1 · Cited by 1 · see citing works
Self-citation
Association between epidural labor analgesia and neonatal infection risk in full-term vaginal deliveries: A retrospective study from a tertiary medical center in Northern Taiwan
Tseng, T.-H., Ding, J.-J., Wang, C.-C., Yu, C.-H., & Chang, C.-N. (2026) · Journal of Microbiology Immunology and Infection · doi:10.1016/j.jmii.2026.03.009
Intrapartum Temperature Elevation, Epidural Use, and Adverse Outcome in Term Infants
Greenwell, E. A., Wyshak, G., Ringer, S. A., Johnson, L. C., Rivkin, M. J., & Lieberman, E. (2012) · Obstetrical & Gynecological Survey · doi:10.1097/ogx.0b013e3182562cd7 · Cited by 5 · see citing works
Labor epidural analgesia is independent risk factor for neonatal pyrexia
Agakidis, C., Agakidou, E., Thomas, S., Murthy, P., & Lloyd, D. J. (2011) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.3109/14767058.2010.545923 · Cited by 30 · see citing works
Epidural analgesia during birth and adverse neonatal outcomes: A population-based cohort study
Høtoft, D., & Maimburg, R. D. (2020) · Women and Birth · doi:10.1016/j.wombi.2020.05.012 · Cited by 24 · see citing works

Authors: TÖRNELL, S., EKÉUS, C., HULTIN, M., HÅKANSSON, S., THUNBERG, J., & HÖGBERG, U.
Affiliations: Umeå University (SE)
Karolinska Institutet (SE)
Uppsala University (SE)
Corresponding author: TÖRNELL, S.
ORCID: EKÉUS, C.
HULTIN, M.
HÅKANSSON, S.
HÖGBERG, U.
Venue: Acta Anaesthesiologica Scandinavica
Publisher: Wiley
Published: 2015-02-15
Volume: 59
Issue: 4
Pages: 486-495
ISSN: 0001-5172 (ISSN-L)
1399-6576
DOI: 10.1111/aas.12477
OpenAlex: W1759397537
Cited by: 60
References: 44
Citations by year: 2026: 7 · 2025: 6 · 2024: 4 · 2023: 3 · 2022: 7 · 2021: 10 · 2020: 11 · 2019: 2 · 2018: 2 · 2017: 4 · 2016: 2 · 2015: 2
FWCI: 3.36
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Acta Anaesthesiologica Scandinavica (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
Keywords: epidural analgesia, intrapartum fever, Apgar score, neonatal encephalopathy, neonatal outcomes, labour, confounding by indication, nulliparous women, neonatal seizures
MeSH terms: Adult, Apgar Score, Brain Diseases, Brain Ischemia, Female, Fever, Humans, Infant, Newborn, Pregnancy, Pregnancy Outcome, Registries, Retrospective Studies, Seizures, Sweden, Analgesia, Obstetrical, Delivery, Obstetric, International Classification of Diseases

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Low A pgar score, neonatal encephalopathy and epidural analgesia during labour: a S wedish registry‐based study

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