Labour: epidural-associated fever: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Labour: epidural-associated fever

Sample item

A nulliparous woman with an epidural in labour develops a temperature of 38.2 degrees C, maternal tachycardia, and a normal vaginal discharge, with fetal heart rate baseline of 170 beats per minute. What should be done?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Treat as possible intra-amniotic infection with antibiotics and expedite delivery

Epidural analgesia is associated with maternal intrapartum fever that is often non-infectious, but fever with maternal or fetal tachycardia cannot be assumed sterile. Suspected intra-amniotic infection is treated with intravenous antibiotics (ampicillin with gentamicin) and delivery is planned. The neonate is also evaluated for sepsis.

Option by option

  • A. Withdraw the epidural catheter and observe only

    Removing the catheter does not treat infection.

  • B. Treat as possible intra-amniotic infection with antibiotics and expedite delivery (correct)

    Correct. Fever with fetal tachycardia is treated as infection, with antibiotics and delivery planned.

  • C. Discontinue oxytocin and wait 24 hours

    Waiting 24 hours risks maternal and neonatal sepsis.

  • D. Ignore, because epidural fever is always sterile

    Epidural fever occurs, but assuming it is sterile may miss chorioamnionitis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Treat as possible intra-amniotic infection with antibiotics and expedite delivery. Epidural analgesia is associated with maternal intrapartum fever that is often non-infectious, but fever with maternal or fetal tachycardia cannot be assumed sterile.

Why is "Withdraw the epidural catheter and observe only" not the answer?

Removing the catheter does not treat infection.

Why is "Discontinue oxytocin and wait 24 hours" not the answer?

Waiting 24 hours risks maternal and neonatal sepsis.

Why is "Ignore, because epidural fever is always sterile" not the answer?

Epidural fever occurs, but assuming it is sterile may miss chorioamnionitis.

What concept does this question test?

It tests Labour: epidural-associated fever in OBG. Suspected intra-amniotic infection is treated with intravenous antibiotics (ampicillin with gentamicin) and delivery is planned. The neonate is also evaluated for sepsis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Labour: epidural-associated fever?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.