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Intrapartum fever

Author
Katherine T Chen, MD, MPH
Section Editors
Susan M Ramin, MD
David L Hepner, MD
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

Intrapartum fever (ie, fever during labor) can be due to an infectious or non-infectious etiology and can lead to a variety of maternal and neonatal sequelae. Numerous risk factors for intrapartum fever have been reported, such as nulliparity, prolonged labor, and premature rupture of membranes [1]. These characteristics describe women likely to develop intraamniotic infection (IAI) and/or receive epidural anesthesia, which are the two common causes of intrapartum fever. In the absence of a preexisting febrile disorder (eg, respiratory infection), most pregnant women who develop fever in labor are presumed to have IAI and treated with broad spectrum antibiotics.

MECHANISM

The vast majority of patients with elevated body temperature have fever, which occurs when the hypothalamic thermoregulatory center is reset at a higher temperature by "endogenous pyrogens" produced by specific host cells in response to infection, inflammation, injury, or antigenic challenge. These pyrogenic polypeptides include the cytokines interleukin (IL)-1 alpha and IL-1 beta, IL-6, tumor necrosis factor (TNF)-alpha and TNF-beta, and interferon alpha [2,3].

There are a few instances in which an elevated temperature represents hyperthermia rather than fever. As an example, some pharmacologic agents (eg, atropine, the recreational drug "ecstasy") raise core temperature by blocking sweating or vasodilation without changing the normal hypothalamic set-point. (See "Pathophysiology and treatment of fever in adults" and "Drug fever".)

For the purposes of this discussion, the term fever will generally be used to describe maternal intrapartum temperature elevation from any mechanism.

DEFINITION

Fever is defined as an elevation of body temperature above normal daily variation. The threshold for intrapartum fever has generally been considered to be maternal temperature ≥38 degrees C (≥100.4 degrees F) orally. This is based, in part, on a study of temperature in normal parturients, which ranged from 34.6 to 37.6 degrees C (94.3 to 99.7 degrees F) upon admission to the labor unit [4]. There was a diurnal distribution, with a peak from midnight to 2 AM and a nadir from 11 AM to noon.

                            

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Literature review current through: Nov 2016. | This topic last updated: Fri Sep 09 00:00:00 GMT+00:00 2016.
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