Why Shiver?

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Notes from Truelearn and UpToDate on Shivering in OB

Shivering during labor

• 10-20% of laboring patients without epidural, 30-55% with epidural
• multifactorial
• hormonal changes: less progesterone than normal cycle results in less NE -> less augmentation of core temps
• immunological reaction to fetomaternal transfusion
• use of Misoprostol
• possibly non-thermogenic: bursting tremor similar to clonus
• Epidural shivering from central hypothermia and peripheral vasoconstriction
• First hour with an epidural: core heat -> periphery 2/2 neuraxial blunt autonomic thermoregulatory below level of blockade, vasodilation causes redistribution of heat

Prevention and Treatment

• Warming prior to epidural/spinal placement can decrease shivering
• Warming after shivering
• Dopaminergic/seretonergic pathway drugs can reduce shivering (25mg IV Meperidine (demerol), clonidine, tramadol, ketamine, dexmedatomidine)