Predictors for poor maternal and neonatal outcomes in parturients with intrapartum fever: a case-control study

Authors

  • Yuen Chung TANG
  • Sau Kam Liliana LAW
  • Po Lam SO

DOI:

https://doi.org/10.12809/hkjgom.23.1.03

Keywords:

Chorioamnionitis, Fever, Infant, newborn, Maternal health

Abstract

Objective: This study aims to determine the predictors for intrapartum fever and for poor maternal and neonatal outcomes in parturients with intrapartum fever, and to evaluate the pathogens involved and their resistance to antibiotics.
Methods: Medical records of patients with intrapartum fever and singleton delivery at term in Tuen Mun Hospital, Hong Kong between 1 July 2020 and 31 June 2021 were retrieved. Each patient was matched with a consecutive healthy control by parity and gestational age. The case and control groups were compared in terms of composite adverse maternal and neonatal outcomes. Multivariate analyses were used to determine predictors for intrapartum fever and for poor maternal and neonatal composite outcomes. Pathogens isolated from maternal, placental, and neonatal specimens were evaluated, as was their resistance to antibiotics.
Results: The incidence of intrapartum fever was 4.4% (164/3729). In multivariate analysis, predictors for intrapartum fever were hypertensive disease (adjusted odds ratio [aOR]=7.42, p=0.015), epidural analgesia (aOR=6.22, p<0.001), and duration of ruptured membranes (aOR=1.07, p=0.044). Epidural analgesia was a predictor for composite adverse maternal outcome (aOR=2.65, p=0.007), whereas maternal temperature of ≥39°C was a predictor for composite adverse neonatal outcome (aOR=5.15, p=0.036). Positive bacterial culture was not associated with poor neonatal outcomes. Higher degrees of maternal temperature were associated with higher composite maternal and neonatal morbidity. 89 (54.3%) of febrile patients had positive culture results. Enterococcus was the most common gram-positive organism (48.1%) and Escherichia coli was the most common gram-negative bacteria (65.2%).
Conclusion: Intrapartum fever is associated with poor maternal and neonatal outcomes. Obstetricians should avoid long duration of labour and high maternal temperature. The choice of antibiotics for intrapartum fever/chorioamnionitis should be carefully selected, with consideration of efficacy, possible adverse effects, and antimicrobial resistance.

References

Burgess APH, Katz JE, Moretti M, Lakhi N. Risk factors for intrapartum fever in term gestations and associated maternal and neonatal sequelae. Gynecol Obstet Invest 2017;82:508-16.

Committee Opinion No. 712: Intrapartum Management of Intraamniotic Infection. Obstet Gynecol 2017;130:e95-e101.

Higgins RD, Saade G, Polin RA, et al. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: summary of a workshop. Obstet Gynecol 2016;127:426-36.

Gonen R, Korobochka R, Degani S, Gaitini L. Association between epidural analgesia and intrapartum fever. Am J Perinatol 2000;17:127-30.

Hensel D, Zhang F, Carter EB, et al. Severity of intrapartum fever and neonatal outcomes. Am J Obstet Gynecol 2022;227:513.e1-513.e8.

Dior UP, Kogan L, Eventov-Friedman S, et al. Very high intrapartum fever in term pregnancies and adverse obstetric and neonatal outcomes. Neonatology 2016;109:62-8.

Hochler H, Lipschuetz M, Guedalia J, et al. The impact of peak and duration of maternal intrapartum fever on perinatal outcomes. Am J Obstet Gynecol MFM 2021;3:100390.

Ashwal E, Salman L, Tzur Y, et al. Intrapartum fever and the risk for perinatal complications — the effect of fever duration and positive cultures. J Matern Fetal Neonatal Med 2018;31:1418-25.

Petrova A, Demissie K, Rhoads GG, Smulian JC, Marcella S, Ananth CV. Association of maternal fever during labor with neonatal and infant morbidity and mortality. Obstet Gynecol 2001;98:20-7.

Borzychowski AM, Sargent IL, Redman CW. Inflammation and pre-eclampsia. Semin Fetal Neonatal Med 2006;11:309-16.

Heesen M, Klöhr S, Rossaint R, Straube S, Van de Velde M. Labour epidural analgesia and anti-infectious management of the neonate: a meta-analysis. J Perinat Med 2012;40;625-30.

Curtin WM, Katzman PJ, Florescue H, Metlay LA, Ural SH. Intrapartum fever, epidural analgesia and histologic chorioamnionitis. J Perinatol 2015;35:396-400.

Morton S, Kua J, Mullington CJ. Epidural analgesia, intrapartum hyperthermia, and neonatal brain injury: a systematic review and meta-analysis. Br J Anaesth 2021;126:500-15.

Ren J, Wang T, Yang B, et al. Risk factors and safety analyses for intrapartum fever in pregnant women receiving epidural analgesia during labor. Med Sci Monit 2021;27:e929283.

Fusi L, Steer PJ, Maresh MJ, Beard RW. Maternal pyrexia associated with the use of epidural analgesia in labour. Lancet 1989;1:1250-2.

Goodlin RC, Chapin JW. Determinants of maternal temperature during labor. Am J Obstet Gynecol 1982;143:97-103.

Riley LE, Celi AC, Onderdonk AB, et al. Association of epidural-related fever and noninfectious inflammation in term labor. Obstet Gynecol 2011;117:588-95.

Jiang Z., Hu X, Zeng H, et al. Nomogram for perinatal prediction of intrapartum fever: a retrospective case-control study. BMC Pregnancy Childbirth 2021;21:445.

Bos EME, Hollmann MW, Lirk P. Safety and efficacy of epidural analgesia. Curr Opin Anaesthesiol 2017;30:736-42.

Practice bulletins No. 139. Premature rupture of membranes. Obstet Gynecol 2013;122:918-30.

Middleton P, Shepherd E, Flenady V, McBain RD, Crowther CA. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more) Cochrane Database Syst Rev 2017;1:CD005302.

Melamed N, Berghella V, Ananth CV, Lipworth H, Yoon EW, Barrett J. Optimal timing of labor induction after prelabor rupture of membranes at term: a secondary analysis of the TERMPROM Study. Am J Obstet Gynecol 2022;S0002-9378(22)00742-6.

Penuela I, Isasi-Nebreda P, Almeida H, López M, Gomez-Sanchez E, Tamayo E. Epidural analgesia and its implications in the maternal health in a low parity community. BMC Pregnancy Childbirth 2019;19:52.

Bannister-Tyrrell M, Ford JB, Morris JM, Roberts CL. Epidural analgesia in labour and risk of caesarean delivery. Paediatr Perinat Epidemiol 2014;28:400-11.

Herrera-Gómez A, Luna-Bertos ED, Ramos-Torrecillas J, Ocaña-Peinado FM, García-Martínez O, Ruiz C. The effect of epidural analgesia alone and in association with other variables on the risk of cesarean section. Biol Res Nurs 2017;19:393-8.

WHO Recommendations for Prevention and Treatment of Maternal Peripartum Infections. Geneva: World Health Organization; 2015.

Chapman E, Reveiz L, Illanes E, Bonfill Cosp X. Antibiotic regimens for management of intra-amniotic infection. Cochrane Database Syst Rev 2014;12:CD010976.

Alrowaily N, D’Souza R, Dong S, Chowdhury S, Ryu M, Ronzoni S. Determining the optimal antibiotic regimen for chorioamnionitis: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021;100:818-31.

Zubikarai M, Huerta S, Blascodeimaz C, et al. Risk factors for intrapartum fever of infectious origin and maternal and neonatal morbidity. J Clin Gynecol Obstet 2022;11:33-8.

Ho PL, Wu TC, editors. Reducing Bacterial Resistance with IMPACT, 5th edition. Hong Kong; 2017.

Kenyon SL, Taylor DJ, Tarnow-Mordi W; ORACLE Collaborative Group. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. ORACLE Collaborative Group. Lancet 2001;357:979-88.

Li YY, Kong CW, To WWK. Pathogens in preterm prelabour rupture of membranes and erythromycin for antibiotic prophylaxis: a retrospective analysis. Hong Kong Med J 2019;25:287-94.

Lyell DJ, Pullen K, Fuh K, et al. Daily compared with 8-hour gentamicin for the treatment of intrapartum chorioamnionitis: a randomized controlled trial. Obstet Gynecol 2010;115:344-9.

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Published

2023-04-06

How to Cite

1.
TANG YC, LAW SKL, SO PL. Predictors for poor maternal and neonatal outcomes in parturients with intrapartum fever: a case-control study. Hong Kong J Gynaecol Obstet Midwifery [Internet]. 2023 Apr. 6 [cited 2024 Jun. 17];23(1). Available from: https://hkjgom.org/home/article/view/326

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