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