Effect of Intrapartum Fever Severity on Maternal and Fetal Outcomes

Abstract

Background Intrapartum fever is a common clinical manifestation in obstetrics, which increases the rates of cesarean section, vaginal instrumental delivery and neonatal asphyxia. The influencing factors of intrapartum fever include pregnancy comorbidities and complications, labor induction duration, labor analgesia, trial delivery time, temperature of delivery room, and number of pelvic examination. These factors can exist independently or be causal. Is it true that the higher maximum body temperature correlates with worse maternal and neonatal outcomes in women with intrapartum fever? The study on it is useful to guide the clinical prognosis and management strategies of pregnant women with intrapartum fever. Objective To investigate the effect of intrapartum fever and its severity on maternal and fetal outcomes during trial delivery of full-term singleton primipara. Methods A total of 994 full-term singleton primiparas who delivered in 2019 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University and diagnosed with intrapartum fever during labor were included as fever group, the full-term singleton primiparas without intrapartum fever who met the criteria were enrolled in a 1∶1 ratio as the control group during the same period. The general situation, complications, labor induction, delivery mode, and maternal and infant outcomes were compared between the fever group and control group. The fever group was further divided into 4 subgroups according to the degree of body temperature at delivery, including 142 cases in subgroup 1 with temperature of 37.3 to <37.5℃, 600 cases in subgroup 2 with temperature of 37.5 to <38 ℃, 213 cases in subgroup 3 with temperature of 38.0 to <38.5 ℃, 39 cases in subgroup 4 with temperature ≥38.5 ℃. General information, obstetric complications, labor induction, delivery mode, and maternal and fetal outcomes of the four subgroups were compared and analyzed. Results A total of 994 cases were included in the fever group and 987 cases in the control group. The proportions of labor induction and induced labor≥3 days in the fever group were higher than those in the control group (P<0.05) . The incidence of premature membrane rupture, gestational hypertension and gestational diabetes in the fever group was higher than the control group (P<0.05) . The rates of cesarean section, puerperal infection, neonatal asphyxia, amniotic fluid contamination neonatal NICU transfer in the fever group were higher than those in the control group (P<0.05) . There was no statistically significant difference between the two groups in terms of neonatal body mass (P>0.05) . There was no statistically significant difference in the rates of labor induction, proportion of induced labor≥3 days and incidence of premature rupture of fetal membranes, gestational hypertension and gestational diabetes among the subgroups (P>0.05) . The differences were not statistically significant when comparing the rates of cesarean delivery, puerperal infection, neonatal asphyxia, amniotic fluid contamination and neonatal NICU transfer among the subgroups (P>0.05) . Conclusion The incidence of maternal complications, labor induction, cesarean section, puerperal infection and neonatal asphyxia increased in patients with fever during labor, the severity of fever was not related to the mode of delivery and maternal and infant outcomes.

Keywords

• intrapartum|fever|degree of fever|cesarean section|asphyxia neonatorum|case-control studies