- Katherine T Chen, MD, MPH
Katherine T Chen, MD, MPH
- Professor of Obstetrics, Gynecology, and Reproductive Science
- Icahn School of Medicine at Mount Sinai
- Section Editors
- Susan M Ramin, MD
Susan M Ramin, MD
- Section Editor — Obstetrics
- Professor of Obstetrics and Gynecology
- Baylor College of Medicine
- David L Hepner, MD
David L Hepner, MD
- Section Editor — Obstetric Anesthesia
- Associate Professor of Anaesthesia
- Harvard Medical School
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 . 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.
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.
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 . 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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- TEMPERATURE MEASUREMENT
- DIAGNOSTIC EVALUATION
- History and physical
- - White blood cell (WBC) count and differential
- - Blood cultures
- - Urine testing
- - Sputum testing
- - Influenza testing
- - Amniotic fluid testing
- - Biological markers
- ETIOLOGY AND MANAGEMENT
- Infectious etiologies
- - Intraamniotic infection (chorioamnionitis)
- - Urinary tract infection
- - Respiratory tract infection
- Noninfectious etiologies
- - Use of epidural anesthesia
- Newborn issues
- - Labor or delivery in an overheated room
- - Drug fever
- FETAL/NEONATAL CONSEQUENCES
- Infection related maternal fever
- Epidural related maternal fever
- MATERNAL CONSEQUENCES
- SUMMARY AND RECOMMENDATIONS