The Association of Maternal Intrapartum Subfebrile Temperature and Adverse Obstetric and Neonatal Outcomes

Abstract

Background: Subfebrile intrapartum maternal temperature is very common, yet there is sparse evidence regarding its causes or its effects on perinatal outcomes. We examined whether mild temperature elevation during labour is a risk marker for adverse obstetric and neonatal outcomes. Methods: A retrospective cohort analysis including 42 601 term, singleton live-births in two medical centres between 2003 and 2010 was performed. This study compared women who experienced a maximal intrapartum temperature of ≤37°C with women who experienced subfebrile intrapartum temperature (37.1-37.9°C). Adjusted risks for adverse obstetric and neonatal outcomes were calculated by using multivariable logistic regression models. Results: Compared with maternal temperature ≤ 37°C, subfebrile temperature was associated with higher rates of primary caesarean deliveries {adjusted odds ratios . Mildly elevated maternal intrapartum temperature (37.1-37.5°C) was also associated with adverse outcomes. Conclusions: Maternal intrapartum subfebrile temperature may be an indicator of operative delivery and neonatal morbidity. Further research is needed to confirm these findings and to reveal underlying mechanisms.

Risk Factors for Intrapartum Fever in Term Gestations and Associated Maternal and Neonatal Sequelae

“…Additionally, oxytocin is often used in the presence of labor dystocia for labor augmentation, which is another potential reason for the association of oxytocin augmentation with intrapartum fever. Although in this study, epidural use was not associated with the development of maternal fever, several other studies have found it to be significant [2, 5, 26]. This study did find the use of meperidine for pain relief to be a significant factor.…”

A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes

“…In the aspects of maternal and neonatal outcomes, conclusions drew from other studies were also controversial . Intrapartum maternal fever has been associated with signs of neurological depression in neonates such as low Apgar scores, hypotonia, supplemental oxygen requirements, assisted ventilation, or cardiopulmonary resuscitation .…”

Epidural analgesia, intrapartum hyperthermia, and neonatal brain injury: a systematic review and meta-analysis

“…Definitions for hyperthermia also varied significantly between studies (!37.5 C up to >38.5 C), including the method of temperature measurement (Table 2; Supplementary Table 2b). Clinical chorioamnionitis, the composite of hyperthermia and at least one additional clinical sign, was the exposure in 13 Five studies were excluded from the meta-analysis: three had no control data, 75,85,91 one had no data on long-term adverse outcomes, 64 available, 65 and the study of Impey and colleagues 72,73 was excluded to prevent double counting of data. In the remaining 31 studies, intrapartum hyperthermia was associated with adverse neonatal neurological outcome (odds ratio: 2.48; 95% CI: 2.28e2.70), although substantial statistical heterogeneity was present (I 2 ¼74%; Fig.…”

“…The likely sources of this heterogeneity are the definition of intrapartum hyperthermia, maternal characteristics, gestational age, and the form of neonatal brain injury. The definition of intrapartum hyperthermia ranged from >37.0 to >38.5 C. 64,83 This lack of consistency is likely caused by geographical and temporal variations in the definition of intrapartum hyperthermia. 96,99 Clinical chorioamnionitis was the exposure or outcome in 15 studies (Table 2).…”