title: Intrapartum fever and the risk for perinatal complications - the effect of fever duration and positive cultures.
abstract: OBJECTIVE
  To estimate the association between intrapartum fever and adverse perinatal outcome.
  
  
  METHODS
  A retrospective cohort study of women attempting vaginal delivery at term in a tertiary hospital (2012-2015). Perinatal outcome of deliveries complicated by intrapartum fever (≥38.0 °C) were compared to women with no intrapartum fever matched by parity and gestational age at delivery in a 1:2 ratio. Maternal outcome included cesarean section (CS), operative vaginal delivery (OVD), retained placenta or post-partum hemorrhage. Neonatal outcome included 5-minute Apgar score <7, umbilical artery pH <7.1, meconium aspiration syndrome, need for mechanical ventilation or hypoxic ischemic encephalopathy.
  
  
  RESULTS
  Overall, 309 women had intrapartum fever and 618 served as controls. Women with intrapartum fever had higher rates of OVD (34.3 versus 19.6%, p < .001) and CS (20.7 versus 8.7%, p < .001). In multivariate analysis, intrapartum fever was independently associated with adverse maternal (3.75, 95%CI 2.65-5.30, p < .001) and neonatal outcome (3.39, 95%CI 1.78-6.45, p < .001). In febrile women, fever duration was related to maternal complications, specifically to CS. In addition, maternal bacteremia and positive placental cultures were risk factors for neonatal complications compared to those with negative cultures (23.3 versus 9.8%, p = .01).
  
  
  CONCLUSIONS
  Intrapartum fever was associated with adverse perinatal complications. The duration of intrapartum fever, maternal bacteremia, and positive cultures further increase this risk.
authors.affiliation: a Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel.|b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Ashwal
authors.affiliation: a Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel.|b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: Lina
authors.initials: L
authors.lastname: Salman
authors.affiliation: b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.|c Lis Maternity and Women's Hospital , Tel-Aviv Sourasky Medical Center , Tel Aviv , Israel.
authors.forename: Yossi
authors.initials: Y
authors.lastname: Tzur
authors.affiliation: b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.|c Lis Maternity and Women's Hospital , Tel-Aviv Sourasky Medical Center , Tel Aviv , Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Aviram
authors.affiliation: b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.
authors.forename: Tali
authors.initials: T
authors.lastname: Ben-Mayor Bashi
authors.affiliation: b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.|c Lis Maternity and Women's Hospital , Tel-Aviv Sourasky Medical Center , Tel Aviv , Israel.
authors.forename: Yariv
authors.initials: Y
authors.lastname: Yogev
authors.affiliation: b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.|c Lis Maternity and Women's Hospital , Tel-Aviv Sourasky Medical Center , Tel Aviv , Israel.
authors.forename: Liran
authors.initials: L
authors.lastname: Hiersch
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000150:complications; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000097:blood / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000209:etiology; D010920:Placenta / Q000382:microbiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: Adverse outcome; culture; intrapartum fever; neonatal outcome