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Q&A

Obstetric Quality and Safety

Poster Session 3

(856) Intrapartum Maternal Fever and Severe Maternal Morbidity

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Rachel P. Gerber, MD

    Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
    Manhasset, NY, United States

    • Coauthor(s)

  • Insaf Kouba, MD (she/her/hers)

    Fellow, Division of Maternal-Fetal Medicine
    Zucker School of Medicine at Hofstra of Northwell
    Bay Shore, NY, United States

  • FJ

    Frank I. Jackson, DO

    Zucker School of Medicine at Hofstra of Northwell
    Bay Shore, NY, United States

  • MB

    Matthew J. Blitz, MD

    Zucker School of Medicine at Hofstra of Northwell
    Bay Shore, NY, United States

Objective:

To determine the association between severity of intrapartum maternal fever and severe maternal morbidity (SMM).


Study Design: Retrospective cohort of all deliveries that occurred at 7 hospitals within a large health care system in New York from 2019-2022. Pregnancies without intrapartum temperature data were excluded. Clinical and sociodemographic data were obtained from the electronic medical record system. The primary exposure was maximum temperature prior to delivery. The cohort was divided into three groups: afebrile (<38.0 °C), mild fever (≥ 38.0°C – 39.0°C), moderate-severe fever (≥ 39.0°C). The primary outcome was SMM, defined using the Centers for Disease Control and Prevention (CDC) criteria. Multivariable logistic regression was used to evaluate the association between maximum maternal temperature and SMM, adjusting for potential confounders.

Results: A total of 65,246 deliveries were included for analysis: 96.4% (n=62,918) afebrile, 3.2% (n=2,092) mild fever, and 0.4% (n=236) moderate-severe fever. The overall rate of SMM was 4.3% (n=2,780), which occurred in 4.0%, 9.3%, and 22.9% of the afebrile, mild fever, and moderate-severe fever groups, respectively (p < 0.001). On multivariable logistic regression analysis, SMM was 2.41 and 7.55 times more likely in pregnancies complicated by mild or moderate-severe fever compared to afebrile patients (95% CI 2.03-2.86 and 5.36-10.47, respectively).

Conclusion: Maternal intrapartum fever is an independent predictor of SMM. Further investigation is warranted to determine the optimal timing of antibiotic administration to effectively reduce this risk.