title: High fever following postpartum administration of sublingual misoprostol.
abstract: OBJECTIVE
  To explore what triggers an elevated body temperature of > or =40.0 degrees C in some women given misoprostol, a prostaglandin E1 analogue, for postpartum haemorrhage (PPH).
  
  
  METHODS
  Post hoc analysis.
  
  
  METHODS
  One tertiary-level hospital in Quito, Ecuador.
  
  
  METHODS
  A cohort of 58 women with a fever of above 40 degrees C following treatment with sublingual misoprostol (800 micrograms) for PPH.
  
  
  METHODS
  Side effects were documented for 163 Ecuadorian women given sublingual misoprostol to treat their PPH. Women's body temperatures were measured, and if they had a fever of > or =40.0 degrees C, measurements were taken hourly until the fever subsided. Temperature trends were analysed, and the possible physiological mechanisms by which postpartum misoprostol produces a high fever were explored.
  
  
  METHODS
  The onset, duration, peak temperatures, and treatments administered for cases with a high fever.
  
  
  RESULTS
  Fifty-eight of 163 women (35.6%) treated with misoprostol experienced a fever of > or =40.0 degrees C. High fevers followed a predictable pattern, often preceded by moderate/severe shivering within 20 minutes of treatment. Body temperatures peaked 1-2 hours post-treatment, and gradually declined over 3 hours. Fevers were transient and did not lead to any hospitalisation. Baseline characteristics were comparable among women who did and did not develop a high fever, except for known previous PPH and time to placental expulsion.
  
  
  CONCLUSIONS
  An unexpectedly high rate of elevated body temperature of > or =40.0 degrees C was documented in Ecuador following sublingually administered misoprostol. It is unclear why temperatures > or =40.0 degrees C occurred with a greater frequency in Ecuador than in other study populations using similar treatment regimens for PPH. Pharmacogenetic studies may shed further light on variations in individuals' responses to misoprostol.
authors.affiliation: Gynuity Health Projects, New York, NY, USA. jdurocher@gynuity.org
authors.forename: J
authors.initials: J
authors.lastname: Durocher
authors.forename: J
authors.initials: J
authors.lastname: Bynum
authors.forename: W
authors.initials: W
authors.lastname: León
authors.forename: G
authors.initials: G
authors.lastname: Barrera
authors.forename: B
authors.initials: B
authors.lastname: Winikoff
mesh_terms: D000286:Administration, Sublingual; D000328:Adult; D004484:Ecuador; D005260:Female; D005334:Fever / Q000139:chemically induced*; D006801:Humans; D007902:Length of Stay; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects*; D010120:Oxytocics / Q000008:administration & dosage / Q000009:adverse effects*; D017060:Patient Satisfaction; D006473:Postpartum Hemorrhage / Q000517:prevention & control*; D012768:Shivering / Q000187:drug effects; D055815:Young Adult
chemical_list: D010120:Oxytocics; D016595:Misoprostol
references.citation: Obstet Gynecol. 1997 Jul;90(1):88-92
references.pmid: 9207820
references.citation: Gynecol Obstet Invest. 2007;63(1):55-60
references.pmid: 16940738
references.citation: Mol Nutr Food Res. 2006 Apr;50(4-5):451-5
references.pmid: 16534751
references.citation: Hum Reprod. 2001 Jan;16(1):31-35
references.pmid: 11139532
references.citation: J Matern Fetal Neonatal Med. 2009 Jan;22(1):24-8
references.pmid: 19089777
references.citation: BMC Pregnancy Childbirth. 2008 Aug 21;8:40
references.pmid: 18718007
references.citation: Hum Reprod. 2002 Feb;17(2):332-6
references.pmid: 11821273
references.citation: Arch Intern Med. 1998 Sep 28;158(17):1870-81
references.pmid: 9759682
references.citation: Lancet. 2001 Sep 1;358(9283):689-95
references.pmid: 11551574
references.citation: BJOG. 2002 Nov;109(11):1222-6
references.pmid: 12452458
references.citation: Bull World Health Organ. 2009 Sep;87(9):666-77
references.pmid: 19784446
references.citation: Obstet Gynecol. 2003 May;101(5 Pt 1):968-74
references.pmid: 12738159
references.citation: Br J Obstet Gynaecol. 1998 Sep;105(9):971-5
references.pmid: 9763047
references.citation: Cochrane Database Syst Rev. 2007 Jul 18;(3):CD000494
references.pmid: 17636640
references.citation: Am J Med Sci. 1987 Oct;294(4):275-86
references.pmid: 3310641
references.citation: Lancet. 2010 Jan 16;375(9710):210-6
references.pmid: 20060161
references.citation: Cochrane Database Syst Rev. 2007 Jan 24;(1):CD003249
references.pmid: 17253486
references.citation: S Afr Med J. 2001 May;91(5):432-5
references.pmid: 11455810
references.citation: Am J Phys Anthropol. 1970 May;32(3):401-7
references.pmid: 4911586
references.citation: Lancet. 2010 Jan 16;375(9710):217-23
references.pmid: 20060162
references.citation: Br J Obstet Gynaecol. 1997 Mar;104(3):336-9
references.pmid: 9091012
references.citation: Neurosci Biobehav Rev. 1993 Fall;17(3):237-69
references.pmid: 8272282
references.citation: J Midwifery Womens Health. 2009 Mar-Apr;54(2):133-141.e1
references.pmid: 19249659
references.citation: Obstet Gynecol. 1997 Oct;90(4 Pt 2):703-4
references.pmid: 11770608
references.citation: Br J Obstet Gynaecol. 1999 Apr;106(4):304-8
references.pmid: 10426235
references.citation: Clin Obstet Gynecol. 2000 Sep;43(3):455-68
references.pmid: 10949750
references.citation: Neuroscience. 1998 Apr;83(4):1239-43
references.pmid: 9502261
references.citation: Best Pract Res Clin Obstet Gynaecol. 2008 Dec;22(6):1025-41
references.pmid: 18786863
references.citation: Comp Biochem Physiol A Mol Integr Physiol. 2007 Jul;147(3):616-639
references.pmid: 16950637
references.citation: BMC Pregnancy Childbirth. 2004 Aug 6;4(1):16
references.pmid: 15298718
references.citation: Clin Chim Acta. 2006 Sep;371(1-2):13-24
references.pmid: 16549059
references.citation: J Reprod Immunol. 2008 Oct;79(1):50-7
references.pmid: 18550178
references.citation: Int J Gynaecol Obstet. 2010 Mar;108(3):282-8
references.pmid: 20034628
references.citation: Eur J Obstet Gynecol Reprod Biol. 2004 Jul 15;115(1):108-9
references.pmid: 15223178
references.citation: AANA J. 2006 Apr;74(2):145-50
references.pmid: 16617919
references.citation: Lancet. 2007 Jun 9;369(9577):1938-46
references.pmid: 17560446