Am J Obstet Gynecol. 2024 Jun 11:S0002-9378(24)00665-3. doi: 10.1016/j.ajog.2024.05.054. Online ahead of print.
ABSTRACT
BACKGROUND: Intrapartum fever (>38°C) is associated with adverse maternal and neonatal outcomes. However, the correlation between low-grade fever (37.5-37.9°C) and adverse perinatal outcomes is controversial.
OBJECTIVE: To compare maternal and neonatal outcomes of women with prolonged rupture of membranes (ROM) (>12h) at term, between those with low-grade fever and those with normal body temperature.
STUDY DESIGN: This retrospective study included women hospitalized in a tertiary university-affiliated hospital between July 2021 and May 2023, with singleton term and ROM>12h. Women were classified as having intrapartum low-grade fever (37.5°-37.9°C) or normal body temperature (<37.5°C). The co-primary outcomes: postpartum endometritis and neonatal intensive care unit admission (NICU) rates were compared between these groups. Secondary maternal outcomes comprised: intrapartum leukocytosis (>15,000/mm2), cesarean delivery rate, postpartum hemorrhage, postpartum fever, surgical site infection, and postpartum length of stay. Secondary neonatal outcomes were early onset sepsis, 5-minute Apgar score <7, umbilical artery cord pH<7.2 and pH<7.05, NICU length of stay, and respiratory distress. The data were analyzed according to ROM 12-18h and ROM>18h. The later received intrapartum ampicillin and chorioamniotic-membrane swabs were obtained. Likelihood ratios and 95% confidence intervals (CI) were calculated for the co-primary outcomes. A multivariate logistic regression model aimed to predict puerperal endometritis controlled for ROM duration, low-grade fever (compared to normal body temperature), positive group B streptococcus (GBS) status, mechanical cervical ripening, cervical ripening by prostaglandins, artificial rupture of membranes (AROM), meconium staining, epidural analgesia, and cesarean delivery. A multivariate logistic regression model aimed to predict NICU admission controlled for ROM-duration, low-grade fever, positive GBS status, mechanical cervical ripening, AROM, meconium staining, cesarean delivery, and neonatal weight <2500 grams.
RESULTS: Included were 687 women with ROM 12-18h and 1109 with ROM>18h. In both latency groups, among those with low-grade fever vs. normal body temperature, the rates were higher for cesarean delivery, endometritis, surgical site infections, umbilical cord pH<7.2, NICU admission and sepsis work-up. Among those with low-grade fever, the positive likelihood ratios were 12.7, CI 9.6-16.8 and 3.2, CI 2.0-5.30 for puerperal endometritis and NICU admission, respectively. Among women with ROM>18h, the rates were higher of Enterobacteriaceae isolates in chorioamniotic membrane cultures for those with low-grade fever vs. normal intrapartum temperature (22.0% vs. 11.0%, p=0.006). Low-grade fever (odds ratio (OR) 9.0, 95%, CI 3.7-21.9), AROM (OR 4.2, 1.5-11.7, p=0.007), and cesarean delivery (OR 5.4, CI 2.2-13.4, p<0.001) were independently associated with puerperal endometritis. Low-grade fever (OR 3.2, 95% CI 1.7-6.0, p<0.001) and cesarean delivery (OR 1.9, CI 1.1-13.1, p=0.023) were independently associated with NICU admission.
CONCLUSIONS: In women with ROM>12h at term, we report higher maternal and neonatal morbidity among those with low-grade fever vs. normal body temperature. Low-grade fever was associated with a higher risk of Enterobacteriaceae isolates in chorioamniotic membrane cultures and might be the initial presentation of peripartum infection.
PMID:38871240 | DOI:10.1016/j.ajog.2024.05.054
