OAA Large Project Grant
Elucidating the molecular mechanism underlying epidural-related maternal
fever
Dr Gareth Ackland
In the United Kingdom, approximately one-third of women in labour receive pain relief via an epidural. An epidural is a type of pain relief provided by an anaesthetist in which a plastic tube is placed into a space in the woman's back and through which an infusion of pain killers and local anaesthetic is delivered throughout the labour. The epidural is usually kept in the woman's back throughout labour and is normally removed following delivery of the baby. Approximately one quarter of women who have an epidural during labour suffer from a high temperature or fever (also known as epidural-related maternal fever or ERMF). Nobody knows the exact cause of this fever. The aim of this project is to find out the cause of ERMF. Fever during labour is a real problem which can result in more stressful labour for mother and baby and higher hospital costs, in terms of requirement of treatment with antibiotics (for mother and baby) and the need for Caesarean delivery or forceps delivery of the baby in the operating theatre since obstetricians frequently suspect harm to the baby if the mother has fever.
Local anaesthetics which are injected down the epidural not only reduce pain, but also have profound effects on other cells within the body. The local anaesthetics which help make women comfortable during labour and delivery can also cause damage to important parts of immune cells, which result in harmful products being released within the cells and into the body's circulation. The process of harmful substances being released by cells into the circulation of the body may be the cause of epidural-related fever in the mother. We plan to investigate whether the local anaesthetic used in epidurals causes fever through the release of fever-inducing substances by performing several different tests on immune cells from women who are in labour. We will recruit two groups of women: those receiving an epidural for pain relief and those who do not utilise epidural analgesia. We will insert an IV drip into women who agree to take part in the study which is used routinely as part of their hospital stay, thereby minimizing unnecessary discomfort. While inserting the IV drip a teaspoon of blood will be taken for various laboratory tests. Four hours later another teaspoon of blood will be taken from the same woman. We will then compare markers of cell damage and the production of substances that cause fever in the blood samples before and after epidural local anaesthetic has been administered. If local anaesthetic is found to affect immune function and be a cause of fever, these results will enable us to identify the cause of fever in individual women in labour and help avoid unnecessary clinical interventions and antibiotic administration in the future.
