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The febrile parturient: choice of anesthesia

Fever is a common clinical problem in labor and delivery suites - worldwide. The febrile parturient presents a unique diagnostic dilemma and therapeutic challenge to both an obstetrician and an anesthesiologist involved in her care. Fever can result from a variety of infectious microorganisms, tissue trauma, malignancy, drug administration, endocrine and immunological disorders. However, infection is by far the most common cause of fever in the parturient.  The infectious etiology of fever in a parturient may be pregnancy specific, such as chorioamnionitis, or not specific to pregnancy, such as urinary tract infection. The risk to the mother and the fetus is significantly increased in pregnancy complicated by infection and fever. The diverse clinical manifestations of various infectious disorders combined with the unique anesthetic implications of pregnancy may result in life-threatening complications and significantly impact upon the practice of obstetric anesthesia. The diagnosis of infection in pregnancy often raises questions about the safety of neuraxial anesthesia in febrile patients. Despite this concern, and lack of universal guidelines, it has now been well established that the presence of infection and fever in labor does not always contraindicate the administration of regional anesthesia. The decision whether to administer regional anesthesia or not in a febrile parturient should be based on an individual risk-to-benefit ratio.