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Continuous Intrapartum Maternal and Fetal Temperature Monitoring

Lavesson, Tony LU (2017)
Abstract (Swedish)
The maternal temperature is normally increasing during delivery. Maternal fever in labor is a common problem.
Such fever could represent a chorioamnionitis (CAM), leading to an increased risk of neonatal encephalopathy and
subsequent cerebral palsy, as well as other complications. There are also noninfectious reasons for elevated
temperature during delivery. There is no fetal heart rate that is specific for incipient or manifest CAM. Maternal
fever in labor increases the risk of cesarean section and assisted vaginal delivery.
The fetal intrapartum temperature has been studied sparsely before. Fetal head heat flux has been found to be
related to the metabolic condition of the fetus. Fetal skin temperature has been... (More)
The maternal temperature is normally increasing during delivery. Maternal fever in labor is a common problem.
Such fever could represent a chorioamnionitis (CAM), leading to an increased risk of neonatal encephalopathy and
subsequent cerebral palsy, as well as other complications. There are also noninfectious reasons for elevated
temperature during delivery. There is no fetal heart rate that is specific for incipient or manifest CAM. Maternal
fever in labor increases the risk of cesarean section and assisted vaginal delivery.
The fetal intrapartum temperature has been studied sparsely before. Fetal head heat flux has been found to be
related to the metabolic condition of the fetus. Fetal skin temperature has been found to correlate with changing
temperature and baseline fetal heart rate.
The aim of the present thesis was to investigate the fetal scalp temperature (FST) and maternal axillary
temperature (MAT) during vaginal delivery relative to progression of labor, uterine contractions, epidural analgesia
(EDA), and to construct normal temperature reference ranges related to stage of labor. The purpose was also to
study FST and MAT and the relation to inflammatory response in the placenta. Furthermore, the present thesis
attempted to establish whether paracetamol (acetaminophen) has effect on fetal and maternal temperatures in
labor.
An equipment to continuously record fetal scalp temperature during labor was developed by placing a temperature
sensor in the fetal scalp electrode aimed for fetal heart rate (FHR) monitoring. In the first study the equipment was
validated in a fetal lamb model, where the intracranial and subcutaneous temperatures were measured. The
subcutaneous temperature mirrored the intracranial temperature closely, even in a situation of increasing fetal
hypoxia, with the intracranial temperature being higher.
In the following three studies the equipment was used in a total of 307 deliveries at Helsingborg hospital. The
maternal temperature was measured axillary. The development of FST and MAT was examined during normal
labor. The temperatures increased significantly by progression of labor, and significantly more in the presence of
EDA. Reference intervals for maternal temperature were created. Changes of the FST were not seen during
uterine contractions.
The relation between temperature and histological inflammatory changes was studied. There was a significant
relation between inflammatory changes in the placenta, umbilical cord and amniotic membranes, and maximum
FST and MAT. Women with EDA had significantly more often inflammatory changes.
Paracetamol is the only safe pharmacological choice to try to lower body temperature during delivery. The aim of
the last study was to investigate the effect of paracetamol on maternal and fetal temperatures when given to febrile
parturients. Neither maternal nor fetal temperatures decreased after paracetamol. However, paracetamol halted an
increasing trend and stabilized the fetal temperature, i.e. it has an anti-pyretic effect. (Less)
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author
supervisor
opponent
  • MD, DrMedSc Weber, Tom, Hvidovre Hospital, Danmark
organization
alternative title
Kontinuerlig intrapartal maternell och fetal temperaturmätning
publishing date
type
Thesis
publication status
published
subject
keywords
Maternal, fetal, temperature, fever, pyrexia, labor, uterine contractions, delivery, chorioamnionitis, epidural
pages
72 pages
publisher
Lund University, Faculty of Medicine
defense location
Föreläsningssalen, Avd för obstetrik och gynekologi, Skånes universitetssjukhus i Malmö.
defense date
2017-05-24 13:00
ISBN
978-91-7619-465-2
language
English
LU publication?
yes
id
37f0f3a6-45a9-40a9-8d46-6623c1be7907
date added to LUP
2017-04-28 01:06:37
date last changed
2017-05-02 15:05:14
@phdthesis{37f0f3a6-45a9-40a9-8d46-6623c1be7907,
  abstract     = {The maternal temperature is normally increasing during delivery. Maternal fever in labor is a common problem.<br/>Such fever could represent a chorioamnionitis (CAM), leading to an increased risk of neonatal encephalopathy and<br/>subsequent cerebral palsy, as well as other complications. There are also noninfectious reasons for elevated<br/>temperature during delivery. There is no fetal heart rate that is specific for incipient or manifest CAM. Maternal<br/>fever in labor increases the risk of cesarean section and assisted vaginal delivery.<br/>The fetal intrapartum temperature has been studied sparsely before. Fetal head heat flux has been found to be<br/>related to the metabolic condition of the fetus. Fetal skin temperature has been found to correlate with changing<br/>temperature and baseline fetal heart rate.<br/>The aim of the present thesis was to investigate the fetal scalp temperature (FST) and maternal axillary<br/>temperature (MAT) during vaginal delivery relative to progression of labor, uterine contractions, epidural analgesia<br/>(EDA), and to construct normal temperature reference ranges related to stage of labor. The purpose was also to<br/>study FST and MAT and the relation to inflammatory response in the placenta. Furthermore, the present thesis<br/>attempted to establish whether paracetamol (acetaminophen) has effect on fetal and maternal temperatures in<br/>labor.<br/>An equipment to continuously record fetal scalp temperature during labor was developed by placing a temperature<br/>sensor in the fetal scalp electrode aimed for fetal heart rate (FHR) monitoring. In the first study the equipment was<br/>validated in a fetal lamb model, where the intracranial and subcutaneous temperatures were measured. The<br/>subcutaneous temperature mirrored the intracranial temperature closely, even in a situation of increasing fetal<br/>hypoxia, with the intracranial temperature being higher.<br/>In the following three studies the equipment was used in a total of 307 deliveries at Helsingborg hospital. The<br/>maternal temperature was measured axillary. The development of FST and MAT was examined during normal<br/>labor. The temperatures increased significantly by progression of labor, and significantly more in the presence of<br/>EDA. Reference intervals for maternal temperature were created. Changes of the FST were not seen during<br/>uterine contractions.<br/>The relation between temperature and histological inflammatory changes was studied. There was a significant<br/>relation between inflammatory changes in the placenta, umbilical cord and amniotic membranes, and maximum<br/>FST and MAT. Women with EDA had significantly more often inflammatory changes.<br/>Paracetamol is the only safe pharmacological choice to try to lower body temperature during delivery. The aim of<br/>the last study was to investigate the effect of paracetamol on maternal and fetal temperatures when given to febrile<br/>parturients. Neither maternal nor fetal temperatures decreased after paracetamol. However, paracetamol halted an<br/>increasing trend and stabilized the fetal temperature, i.e. it has an anti-pyretic effect.},
  author       = {Lavesson, Tony},
  isbn         = {978-91-7619-465-2},
  keyword      = {Maternal, fetal, temperature, fever, pyrexia, labor, uterine contractions, delivery, chorioamnionitis, epidural},
  language     = {eng},
  pages        = {72},
  publisher    = {Lund University, Faculty of Medicine},
  school       = {Lund University},
  title        = {Continuous Intrapartum Maternal and Fetal Temperature Monitoring},
  year         = {2017},
}