Very High Intrapartum Fever in Term Pregnancies and Adverse Obstetric and Neonatal Outcomes

Abstract

Background: Intrapartum fever is a well-known risk factor for adverse perinatal outcomes. Maternal intrapartum fever ≥39.0°C at term is a rare event during labor, and there is scarce evidence regarding its implications. Objectives: To investigate the association between very high intrapartum maternal fever and perinatal outcomes in term pregnancies. Methods: A retrospective cohort analysis including 43,560 term, singleton live births in two medical centers between the years 2003 and 2011 was performed. We compared parturients who experienced a maximal intrapartum fever of <38.0°C with two subgroups of parturients who experienced respective maximal fevers of 38.0-38.9°C and ≥39°C. Adjusted risks for adverse perinatal outcomes were calculated by using multiple logistic regression models to control for confounders. Results: Compared with normal intrapartum temperature, intrapartum fever ≥39.0°C was associated with an extremely elevated risk for neonatal sepsis 16.08 (95% CI: 2.15, 120.3) as well as with low Apgar scores and neonatal intensive care unit admissions (p < 0.001). Additionally, very high intrapartum fever was related to significantly higher risk for operative delivery (p < 0.001). Conclusions: Extremely elevated intrapartum fever is an important indicator of severe neonatal morbidity and operative delivery.

Time- and dose-dependent correlations between patient-controlled epidural analgesia and intrapartum maternal fever

“…Other studies found that PCEA was associated with maternal fever, which is an important risk factor for adverse neonatal outcomes, including postpartum hemorrhage and labor dystocia, and is also associated with a higher rate of cesarean section [10]. The effects of fever on newborns include neurodepressive symptoms, such as decreased Apgar scores, a higher likelihood of ventilation and oxygen inhalation, and an increased rate of cardiopulmonary resuscitation [3].…”

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 impact of peak and duration of maternal intrapartum fever on perinatal outcomes

“…It has been repeatedly shown to be strongly associated with various adverse maternal and neonatal outcomes. Maternal complications include the need for cesarean or instrumental delivery, while a high proportion of these are indicated by labor dystocia or suspected fetal distress [2][3][4][5] . Fetal complications include neonatal intensive care unit (NICU) admissions 2 , early onset neonatal sepsis 6 , low Apgar scores 2,7 , hypotonia, assisted ventilation, early-onset seizures 7 , neonatal encephalopathy 8 , hyaline membrane disease, and perinatal mortality 9 , as well as cerebral palsy in the long term 10,11 .…”