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Q&A

Infectious Diseases

Poster Session 1

(98) Is subfebrile fever during prolonged ROM (>12 hours) related to infectious outcomes?

Tuesday, February 13, 2024

10:30 AM – 12:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Presenting Author(s)

Raneen Abu Shqara, MD

Resident
Galilee Medical Center and Azrieli Faculty of Medicine Bar-Ilan University
Nahariya, HaZafon, Israel

Coauthor(s)

YN

Yara Nakhlah, MD

Galilee Medical Center
Nahariya, Israel, HaZafon, Israel
LL

Lior Lowenstein, MD

Galilee Medical Center, Nahariya, Israel Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
Naharyia, HaZafon, Israel

Primary Author(s)

Maya Frank Wolf, MD (she/her/hers)

Director of Maternal-Fetal Unit
Galilee Medical Center, Nahariya, and Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
Nahariya, HaZafon, Israel

Objective:
Women with prolonged rupture of membranes (ROM) are at higher risk for peripartum infections. Definitions for intrapartum fever vary. Generally, when intrapartum fever is ≥38°C, antibiotic treatment should be considered. We compared maternal and neonatal outcomes of women with prolonged ROM ( >12h), between those with subfebrile fever (37.5-37.9°C) and with normal body temperature (< 37.5°C).

Study Design:
This retrospective study included women hospitalized in a tertiary university-affiliated hospital between July 2021 and May 2023. The primary outcome, the endometritis rate, was compared between women with intrapartum subfebrile fever and with normal body temperature. Singleton term, ROM >12h and maximal body temperature of 37.9°C were inclusion criteria. The data were analyzed according to two latency period groups: ROM of 12-18h and ROM >18h. Women with ROM >18h received intrapartum ampicillin for group B streptococcus prophylaxis. Chorioamniotic-membrane swabs were obtained in ROM >18h.

Results: Included were 1796 women: 687 with ROM 12-18h and 1109 with ROM >18h. For both latency groups, among women with subfebrile fever vs. normal body temperature, the rates were higher of endometritis (p< 0.001), surgical site infections (p< 0.001), neonatal intensive care admission (p=0.003) and neonatal fever (p< 0.001) (figure). Respiratory distress syndrome rates were higher among women with subfebrile than normal fever in the ROM 12-18h group (p=0.024). Among women with ROM >18h group, the rates were higher of Enterobacteriaceae isolates in chorioamniotic-membrane cultures, among those who were subfebrile than with normal intrapartum temperature (22% vs 11%, p< 0.001).

Conclusion:
We report higher maternal and neonatal morbidity among women with subfebrile fever and ROM >12h. Subfebrile fever might be the initial presentation of peripartum infection. This is supported by the higher rates of endometritis and surgical site infection. Clinical trials should focus on whether antibiotic treatment should be considered in this context.