MATERNAL INFECTION AND EPIDURAL ANALGESIA OF LABOR - CONTRAINDICATIONS AND OTHER ANALGESIC TECHNIQUES

That the risk of epidural abcess or meningitis is increased in parturients with chorioamniotis has not been confirmed by large epidemiologic surveys. When dural puncture is performed in bacteriemic rats, meningitis is likely to occur, except when antibiotics have been given immediately before dural puncture. According to Chestnut, the anesthesist must weigh the respective risk of general anesthesia (aspiration of gastric contents and failed intubation) and the risk of infectious complications after regional anesthesia. Anesthesiologists have to evaluate the risk of maternal contamination before performing epidural analgesia, using variables available at the beginning of labor. For several authors, the presence of hyperthermia at the beginning of labor may not predict maternal infection. The presence of foetal tachycardia alone or associated with urinary tract infection in the third trimester of pregnancy, of premature rupture of membranes > 24 h, and a prolonged fasting > 14 hours, are good predictors of maternal infection. When the anesthesist decides to perform an epidural analgesia in a infected parturient, because of high risk related to general anesthesia or to obstetric condition, antibiotics should be administered before the epidural puncture. If, on the other hand, the risk of neurologic infectious complication is believed to be high, other analgestic techniques may be used. Patient controlled analgesia may be use intravenously, with fentanyl or alfentanil, during labor, often providing adequate analgesia and maternal satisfaction.