Management of Chills (Shivering) During Labour
Active warming methods including forced air warming and intravenous fluid warming are strongly recommended to prevent and treat chills during labour, as they significantly reduce shivering episodes and improve maternal comfort. 1
Causes of Chills During Labour
- Perioperative hypothermia occurs in 50-80% of patients receiving spinal anesthesia and is a common cause of shivering 1
- Maternal-fetal blood group incompatibility may contribute to postpartum chills in some cases (48% of women with chills vs. 20% without) 2
- Epidural analgesia is a significant risk factor for intrapartum fever and associated chills 3
Prevention of Hypothermia and Associated Chills
Temperature Monitoring
- Oral temperature measurement is the most reliable non-invasive method to reflect intrauterine temperature (correlation coefficient of 0.6) 4
- Appropriate patient temperature monitoring is essential to guide warming interventions (strong recommendation) 1
- Monitor temperature regularly during labour, especially with epidural analgesia 1
Warming Interventions
- Forced air warming devices significantly reduce shivering episodes (p=0.0004) and temperature changes (p=0.0002) 1
- Intravenous fluid warming, when combined with forced air warming, effectively decreases perioperative hypothermia and improves maternal thermal comfort 1
- Increase operating/delivery room temperature to at least 26°C for optimal temperature maintenance 1
Management Algorithm for Chills During Labour
First-Line Interventions
- Apply forced air warming blankets to upper body 1
- Ensure all intravenous fluids are warmed before administration 1
- Increase ambient room temperature 1
- Consider intermittent application of warm packs to lower back and abdomen during first stage of labour 5
For Persistent Chills
- Administer acetaminophen for fever management if temperature exceeds 38°C 1, 3
- Consider prophylactic NSAIDs to reduce severity of chills 1
- For severe rigors, parenteral opioids such as meperidine or hydromorphone may be used per institutional protocols 1
Special Considerations
- Maintain maternal temperature between 36.5°C and 37.5°C to optimize neonatal outcomes 1
- Avoid hyperthermia (>38°C) due to associated risks of adverse neonatal outcomes 1, 6
- Even mild temperature elevations (37.5-38°C) increase risk of neonatal complications 6
- Duration of fever exposure correlates with increased risk of hypoxic-ischemic encephalopathy 6
Importance of Managing Chills and Preventing Hypothermia
Perioperative hypothermia is associated with multiple complications including:
- Surgical site infection
- Altered drug metabolism
- Coagulopathy
- Prolonged hospitalization
- Poor patient satisfaction 1
Maternal fever (>38°C) increases risks of:
Intermittent local heat and cold therapy is an effective non-pharmacological method to relieve labour pain without adverse maternal or fetal outcomes 5
Pitfalls to Avoid
- Don't ignore even mild temperature elevations (37.5-38°C), as they are associated with increased risk of neonatal complications 6
- Avoid hyperthermia (>38°C) as it can adversely affect neonatal outcomes including encephalopathy 1, 6
- Don't delay implementation of warming measures - early intervention is key to preventing complications 1
- Skin temperature monitoring alone is inadequate as it typically reads 2.0-4.0°C less than core temperature 1