title: Association between infection and fever in terminations of pregnancy using misoprostol: a retrospective cohort study.
abstract: Fever is a well-known side effect of misoprostol, but clinically difficult to distinguish from an intra uterine infection. The aim of this study was to determine the incidence of fever in terminations of pregnancy (TOP) using misoprostol and to evaluate fever as indication of intra uterine infection.
  
  
  
  A retrospective cohort study was performed. Consecutive second trimester TOP with misoprostol between January 2008 and October 2012 were selected. We included 403 cases and determined the incidence of fever. To examine intra uterine infection as plausible cause of fever, pathological examination reports of placentas were reviewed for signs of infections.
  
  
  
  The incidence of fever was 42%. Logistic regression showed a dose dependent association between dosage misoprostol and degree of fever (OR 1.86; 95% CI: 1.3-2.7). There was no association between fever and epidural analgesia. Fever has a sensitivity of 55% and a specificity of 58% as a marker of intra uterine infection. The positive predictive value of fever for an intra uterine infection is 4% and the negative predictive value is 98%.
  
  
  
  Administration of misoprostol for the indication TOP is strongly associated with fever during labor. Fever is a poor predictor of intra uterine infection in the context of TOP.
authors.affiliation: Department Obstetrics and Gynecology, Division Woman & Baby, UMC, Lundlaan 6, 3508 AB, Utrecht, The Netherlands. t.a.j.nijman@gmail.com.
authors.forename: Tobias A J
authors.initials: TA
authors.lastname: Nijman
authors.affiliation: Department Obstetrics and Gynecology, VUmc, Amsterdam, The Netherlands.
authors.forename: Kevin G J A
authors.initials: KG
authors.lastname: Voogdt
authors.affiliation: Department Obstetrics and Gynecology, VUmc, Amsterdam, The Netherlands.
authors.forename: Pim W
authors.initials: PW
authors.lastname: Teunissen
authors.affiliation: Department Pathology, VUmc, Amsterdam, The Netherlands.
authors.forename: Patrick J Jp
authors.initials: PJ
authors.lastname: van der Voorn
authors.affiliation: Department Obstetrics and Gynecology, VUmc, Amsterdam, The Netherlands.
authors.forename: Christianne J M
authors.initials: CJ
authors.lastname: de Groot
authors.affiliation: Department Obstetrics and Gynecology, VUmc, Amsterdam, The Netherlands.
authors.forename: Petra C A M
authors.initials: PC
authors.lastname: Bakker
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000009:adverse effects*; D000028:Abortion, Induced / Q000009:adverse effects* / Q000379:methods; D000328:Adult; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016595:Misoprostol / Q000008:administration & dosage / Q000009:adverse effects*; D009426:Netherlands / Q000453:epidemiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011645:Puerperal Infection / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014591:Uterine Diseases / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol
keywords: Abortion; Fever; Infection; Misoprostol; Termination of pregnancy