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Oral Concurrent Session 8 - Labor & Delivery

Oral Concurrent Sessions

(84) Increasing Number of Cervical Examinations in Labor: Does a Risk of Intrapartum Fever Actually Exist?

Wednesday, February 14, 2024
5:15 PM – 5:30 PM  
Location: Potomac Ballroom C, Ballroom Level
Foundation Awardee
Objective: Intrapartum fever is a significant contributor to maternal and neonatal morbidity. Theory persists that laboring patients who receive multiple cervical examinations are at increased risk of intrapartum fever. A prior single center study suggested that no such relationship exists once accounting for time in labor, possibly due to unique, homogeneous labor management at that center. We assessed the relationship between cervical exams and intrapartum fever among a diverse population at a tertiary center with a wide spectrum of labor management approaches by both private and university providers.

Study Design: A retrospective cohort of singleton pregnancies delivering at ≥37 weeks over a 3yr period. Patients who developed intrapartum fever ( > 38.0C) were compared to afebrile ones. Patients were included if they reached the second stage of labor. Patients were stratified into three groups of number of cervical exam by tertials. Time-to-event analyses were used to account for length of labor; Cox proportional hazard models adjusted for induction, bishop score >5 and rupture of membranes.

Results: Of the 3,366 patients, 153 (4.6%) developed intrapartum fever. Women who developed fever had a greater number of cervical exams (median 7, interquartile range [IQR] 5-9) compared to women without fever (median 5, IQR 4-6). However, when accounting for labor duration, the risk of fever significantly decreased as the number of cervical exams increased; women who had ≥7 exams had the lowest risk (HR 0.21, 95% CI 0.11-0.39), compared to women with 1-4 exams.

Conclusion: After accounting for time in labor, increasing number of cervical exams in term labor management does not increase risk of maternal fever. Misconception that increasing number of cervical exams increases the risk of febrile morbidity is most likely due to the confounding of time in labor. Our data suggest that clinically indicated cervical exams should not be avoided due to concern of fever, and that the literature should be collectively evaluated to analyze these findings with those from prior studies to assess the strength of this relationship.