Key takeaways:
- Epidural-related maternal fever occurred in 2% to 66.7% of patients across included trials, underscoring its variability and clinical relevance.
- Conventional epidural analgesia increased the risk of maternal fever, with odds ratios ranging from 1.74 to 5.28 compared with placebo.
- Epidural analgesia combined with magnetic bead auricular point therapy was associated with the greatest reduction in fever risk (OR, 0.29–0.40).
- Electroacupuncture and prophylactic steroids also lowered the risk of epidural-related maternal fever (ORs, 0.43 and 0.45, respectively).
- Network meta-analysis ranked magnetic bead auricular point therapy as the most effective preventive strategy, with low heterogeneity and no significant publication bias.
Epidural-related maternal fever (ERMF) can complicate labor, but a recent network meta-analysis suggests that adding magnetic bead auricular point therapy, electroacupuncture, or prophylactic steroids to epidural analgesia significantly lowers this risk.1
Epidural analgesia has a well-established safety profile for mothers and neonates, making it the gold standard for managing pain during labor.2 However, intrapartum fever occurs in 15% to 25% of parturients receiving epidural analgesia, raising the likelihood of increased antibiotic use, higher cesarean rates, and neonatal interventions such as neonatal intensive care unit admission.1
“Epidural anesthesia with magnetic bead auricular point therapy was ranked as the best preventive intervention based on the SUCRA and PrBest analysis,” wrote investigators
Preventing ERMF
Investigators performed a systematic review and network meta-analysis (NMA) of randomized controlled trials to evaluate strategies for preventing or treating ERMF. Databases searched included MEDLINE, Embase, CENTRAL, and Web of Science, with no language or publication restrictions.
Trials were eligible if they evaluated epidural analgesia with local anesthetics, with or without adjunct interventions. Spinal anesthesia and epidurals without local anesthetics were excluded. Data extraction covered participant demographics, epidural protocols, adjunct therapies, and definitions of intrapartum fever.
The analysis included 34 trials with 8235 participants. Thirty-three studies focused on prevention, evaluating interventions such as:
- Ultra-low, low, or high concentration local anesthetics
- Patient-controlled epidural analgesia with or without opioids
- Prophylactic steroids and acetaminophen
- Dexmedetomidine
- Electroacupuncture
- Magnetic bead auricular point therapy
- Antibiotics
Fever thresholds varied, but the NMA standardized intrapartum fever as 38°C or greater.
Key findings from the network meta-analysis
Conventional epidural analgesia was associated with an increased risk of ERMF compared with placebo, with odds ratios ranging from 1.74 to 5.28 depending on local anesthetic concentration. By contrast, epidural analgesia combined with magnetic bead auricular point therapy significantly reduced fever risk, with odds ratios between 0.29 and 0.40.
Electroacupuncture lowered the risk of ERMF with an odds ratio of 0.43, and prophylactic steroids had an odds ratio of 0.45. Only 2 preventive strategies—low- and high-concentration PCEA—were associated with higher risk of ERMF compared with placebo (odds ratios 2.01 and 2.33, respectively). The incidence of ERMF across the included trials ranged from 2% to 66.7%, reflecting variation in baseline populations and interventions.
Implications for obstetric practice
These findings highlight the potential value of integrating nonpharmacologic and pharmacologic adjuncts into epidural analgesia protocols. Magnetic bead auricular point therapy was identified as the most effective preventive measure, followed by electroacupuncture and prophylactic steroids.
"Health care providers should continue to offer this analgesic modality while maintaining appropriate surveillance for potential complications," wrote investigators.
References
- Yu R, Deng X, Hu N, Xu Chen D. Comparative effectiveness of diverse strategies for the prevention or treatment of epidural-related maternal fever: a systematic review and network meta-analysis of randomized controlled trials. American Journal of Obstetrics & Gynecology. 2025;233(6):581-590. doi:10.1016/j.ajog.2025.07.029
- Patel S, Ciechanowicz S, Blumenfeld YJ, Sultan P. Epidural-related maternal fever: incidence, pathophysiology, outcomes, and management. American Journal of Obstetrics & Gynecology. 2023;228(5). doi:10.1016/j.ajog.2022.06.026
