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Abstract Background Labor epidural analgesia has been suggested to be associated with intrapartum fever. We designed this study to investigate the effects of epidural analgesia and combined spinal-epidural analgesia on maternal intrapartum temperature. Methods Four hundred healthy nullipara patients were randomly assigned to receive either epidural analgesia (EA group) or combined spinal-epidural analgesia (CSEA group). Maternal temperature was measured hourly after analgesia administration. The primary outcome was the incidence of maternal fever, and the secondary outcomes were the duration of analgesia, analgesia to full cervical dilation and analgesia to delivery. Neonatal outcomes and other basic labor events were also recorded. Results Maternal temperature gradually increased with time in both analgesia groups during labor. However, the CSEA group had a lower incidence of maternal fever, and a lower mean maternal temperature at 5 h, 6 h, and 9 h after analgesia. In addtion, the CSEA group also had a shorter time of analgesia duration, analgesia to full cervical dilation, analgesia to delivery, and less dose of epidural local anesthetic than the EA group. Conclusion Our findings suggest that combined spinal-epidural analgesia is associated with a lower risk of intrapartum fever than epidural analgesia. Trial registration ChiCTR1900026606 . Registered on 16/10/2019.

The abnormal characteristics of extremely warm early summer (EWES) in North China under different decadal backgrounds were contrastively analyzed. Their relationships with upper- and lower-level atmospheric circulation and global sea surface temperature anomalies (SSTAs) are also discussed. Results show that temperature anomalies of EWES in North China are overall higher than normal in both cold (1961–1993) and warm (1994–2019) periods, but the anomalies of the latter are much higher than that of the former. EWES in North China is directly related to the circulation lying between 40° and 50°N in the middle troposphere, which leads to positive temperature anomalies occurring from the bottom to the upper level of the troposphere together with a high anomaly trend tilting northward. The persistent and strong Eurasian continental high (ECH) and weak Northeast China cold vortex (NECV) activity, together with the strong western Pacific subtropical high (WPSH) are major factors that directly lead to EWES in North China. ECH and WPSH are stronger and larger, and NECV are weaker and more northward in the warm period than in the cold period. In addition, the positive SSTAs in the tropical Indian Ocean and the Kuroshio area are favorable for the stronger and larger ECH and WPSH as well as the weaker and more northward NECV, causing strong anticyclonic and downward circulation system controlling North China, resulting in the extremely warm temperatures there. The joint impact of the positive tropical Indian Ocean SSTAs and the Kuroshio region SSTAs is more significant during warm than cold periods, resulting in much stronger EWES in North China during warm periods.