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Special Feature: What is the Best Way to Monitor Maternal Temperature in Labor?
By John C. Hobbins
To answer the above question a team of british investigators (Banerjee S, et al. Obstet Gynecol. 2004;103:287-293) inserted an intrauterine temperature sensor in 18 laboring patients with epidural anesthesia at the time they were inserting intrauterine pressure catheters. These patients then were monitored with periodic oral thermometer sampling, continuous skin temp assessment (taped to the inner thigh) and the commonly used ear canal temperature assessments.
Banerjee et al Found:
It is clear from this study that oral temperatures reasonably reflect intrauterine temperature (with a sensitivity of more than 80% and a specificity of 96%) once one adds 0.8ºC to the reading. The study also shows that skin temperature assessments, theoretically representing vasodilation and ear canal methods to reflect tympanic membrane temperature, are poor indicators of maternal core temperature.
That said—how important is it to accurately predict the intrauterine temperature? Data from recent investigation in humans and in personal models suggest the following:
So from the above "true and maybe related," it seems reasonable to keep track of maternal temperature at frequent intervals, and if one excludes intrauterine temperature assessments as being invasive and maternal rectal thermometer assessment as being intrusive (as one patient survey has shown), then, let’s say, hourly oral temp taking could suffice.
Last, one of the earliest clues of increasing maternal core temperature in labor is a fetal tachycardia. Elevation in baseline fetal heart rate is generally not an indirect reflection of fetal infection but simply represents how poorly equipped the fetus is to dissipate heat without the usual mechanisms that infants possess. However, heat by itself may represent potential trouble for the fetus and should be monitored carefully.
John C. Hobbins, MD, Professor and Chief of Obstetrics, University of Colorado Health Sciences Center, Denver is An Associate editor for OB/GYN Clinical Alert.
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