Aim: To determine factors associated with intrapartum fever and to examine associated maternal and neonatal outcomes. Methods: Retrospective study of patients between 36^0/7 and 42^0/7 gestational weeks who entered spontaneous or induced active labor and developed temperature ≥38°C; a similar group that did not develop fever were controls. Univariate and multivariate analyses were performed with p < 0.05 as significant. Results: Fifty-four febrile patients and 306 nonfebrile controls met inclusion criteria. Nulligravidity (45.8 vs. 77.8%, p < 0.001), length of first stage ≥720 min (OR 3.59, 95% CI 1.97-6.55, p < 0.001), length of second stage ≥120 min (OR 4.76, 95% CI 2.29-9.89, p < 0.001), membrane rupture ≥240 min (46.4 vs. 79.6%, p < 0.001), increasing number of vaginal exams (4 vs. 6, p < 0.001), oxytocin (44.8 vs. 63.0%, p = 0.014), and meperidine (14.7 vs. 35.2%, p < 0.001) were all associated with intrapartum fever. Associated morbidity included cesarean delivery (22.5 vs. 44.4%, p = 0.001), Apgar score <7 at 5 min (0.7 vs. 5.6%, p = 0.011), and neonatal intensive care unit admission (9.5 vs. 51.9%, p < 0.001). Conclusion: We have identified several noninfectious factors that are associated with intrapartum fever. Modification of risk factors may improve both maternal and neonatal outcomes.

Objective To determine antepartum and intrapartum factors that are associated with admission to neonatal intensive care unit (NICU) among infants delivered between 36.0 and 42.0 weeks at our institution. Methods The retrospective cohort study included 73 consecutive NICU admissions and 375 consecutive non-NICU admissions. Data on demographic, antepartum, intrapartum and neonatal factors were collected. The primary endpoint defined was admission to NICU. Univariate analyses using the Student’s t-test, Mann-Whitney U-test, χ2 Fisher’s exact test was performed along with multivariate analysis of significant non-redundant variables. Results Those with a significantly higher risk of NICU admission underwent induction of labor with prostaglandin analogs (12.5% vs. 24.7%, P = 0.007). Length of first stage ≥ 720 min (33.5% vs. 51.9%, P = 0.011), length of second stage of labor ≥ 240 min (10.6% vs. 31.6%, P < 0.001) and prolonged rupture of membranes ≥ 120 min (54.0% vs. 80.0%, P = 0.001) were all associated with an increased chance of NICU admission. Intrapartum factors predictive of NICU admission included administration of meperidine (11.7% vs. 27.4%, P < 0.001), presence of preeclampsia (5.5% vs. 0.8%, P = 0.015), use of intrapartum IV antihypertensives (1.1% vs. 13.7%, P < 0.001), maternal fever (5.3% vs. 31.5%, P < 0.001), fetal tachycardia (1.9% vs. 12.3%, P < 0.001), and presence of meconium (30% vs. 8%, P < 0.001). Conclusion Identification of modifiable risk factors may reduce neonatal morbidity and mortality. Results from this study can be used to develop and validate a risk model based on combined antepartum and intrapartum risk factors.

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INTRODUCTION: The objective of this study was to identify modifiable factors and urodynamic parameters predictive of mid-urethral sling (MUS) revision surgery that can be used for counseling patients and individualizing risk prediction. METHODS: Retrospective analysis of 56 sling revisions performed during the 12-year study period. Those with complete medical records (n=40) were matched to 123 control cases that did not require revision, randomly selected from a total of 946 procedures to obtain a 3:1 control: case ratio. Demographic, history, patient reported symptoms, urodynamic study results, intraoperative data, and post-operative data were collected. RESULTS: Significant demographic findings predictive of sling revision included younger age (52.95 vs. 64.48 years, p<0.001) and greater than two previous cesarean deliveries (OR 13.556, 95% CI 1.468-125.137, p=0.013). Presence of posterior pelvic organ prolapse (OR 0.302, 95% CI 0.163-0.803, p=0.011), retropubic sling (OR 2.685, 95% CI 1.037, 6.955, p=0.037) and concomitant apical prolapse repair procedure (OR 3.086, 95% CI 1.299-7.332, p=0.009) was significantly associated with the revision group. Urodynamic factors were not predictive, except a maximum urethral closure pressure less 40 cm H2O was found to be protective (OR 0.0394, 95% CI 0.159-0.978). After multiple regression analysis, younger age, increasing number of cesarean deliveries, and concomitant apical prolapse repair retained statistical significance. CONCLUSION: Urodynamic studies were not useful in determining revision risk as compared to patient age, previous surgical history, and concomitant procedures.