Preventing Perioperative Hypothermia in Obstetric Surgery: A Systematic Review of Warming Methods During Cesarean Birth
Keywords:
Cesarean section, perioperative hypothermia, obstetric anesthesia, warming methods, maternal outcomes, shivering.Abstract
Background:
Perioperative hypothermia is a frequent complication during cesarean birth, associated with maternal shivering, discomfort, coagulopathy, and adverse neonatal outcomes. Effective prevention strategies are essential to improve obstetric surgical safety.
Methods:
We conducted a systematic review of PubMed, Embase, and Cochrane Library from inception to 28 February 2025. Eligible studies included randomized controlled trials or cohort studies evaluating active warming interventions during cesarean delivery under neuraxial anesthesia. The primary outcome was incidence of maternal perioperative hypothermia. Secondary outcomes included intraoperative temperature drop and maternal shivering. Two reviewers independently screened, extracted data, and assessed study quality. Narrative synthesis was applied given methodological heterogeneity.
Results:
Fourteen studies met inclusion criteria, enrolling 2,845 women across diverse geographic regions. Forced-air warming, warmed intravenous fluids, resistive heating, and multimodal combinations were assessed. Incidence of maternal hypothermia ranged from 20–65% in control groups compared with 5–25% in actively warmed groups, corresponding to a relative risk reduction of 35–55%. Combined forced-air and fluid warming was most effective, maintaining mean core temperatures within 0.3 °C of baseline. Maternal shivering occurred in 45–60% of controls versus 10–25% with warming interventions.
Conclusions:
Active warming methods effectively reduced maternal hypothermia and shivering during cesarean birth. Multimodal warming achieved the strongest protection and should be considered for routine implementation in obstetric anesthesia practice.
