From the Guidelines
Hyperthermia during labor and delivery is not common in healthy women with uncomplicated pregnancies. Most women actually experience slight temperature elevations during active labor due to physical exertion, dehydration, and the metabolic demands of labor, but true hyperthermia is uncommon. When significant fever does occur during labor, it's typically associated with specific conditions such as chorioamnionitis, epidural use, or other infections like urinary tract infections or respiratory illnesses. According to a study published in Circulation 1, hyperthermia (temperature greater than 37.5°C) increases the risk for neonatal mortality and morbidity in both term and preterm infants, highlighting the importance of maintaining a normal temperature range during labor and delivery. Management includes identifying and treating the underlying cause, providing adequate hydration, and in cases of infection, appropriate antibiotics. Key points to consider include:
- Temperature monitoring is a standard part of maternal care during labor
- Healthcare providers will investigate any significant temperature elevation to ensure proper treatment
- Women with risk factors for developing fever during labor, such as prolonged rupture of membranes or multiple vaginal examinations, should be monitored more closely
- Strategies to minimize heat loss and prevent hypothermia in newborns, such as occlusive wrapping and warmed humidified resuscitation gases, can also help prevent hyperthermia 1.
From the Research
Intrapartum Fever Prevalence
- Intrapartum fever is a common occurrence during labor, with studies suggesting that it presents diagnostic and treatment dilemmas for clinicians 2.
- The exact prevalence of intrapartum fever is not well-established, but it is estimated that a significant proportion of women experience fever during labor.
Risk Factors for Intrapartum Fever
- Several risk factors have been identified, including the duration of exposure to epidural analgesia and the length of labor in unmedicated women 2.
- A high-dose oxytocin regimen has been shown to lead to clinically meaningful reductions in the rate of intrapartum fever compared to a low-dose oxytocin regimen 2.
- Body mass index and longer time from rupture of membranes to delivery have also been associated with an increased risk of intrapartum fever 3.
Effects of Intrapartum Fever on Mother and Fetus
- Intrapartum fever has been linked to adverse outcomes, including increased risk of cesarean delivery and postpartum hemorrhage 2.
- For the neonate, intrapartum fever has been associated with higher rates of encephalopathy or the need for therapeutic hypothermia, particularly when maternal fever exceeds 39°C 2.
- Fetal hypoxia is often difficult to predict or prevent, and every effort should be made to reduce the risk of intrapartum fever 2.
Management of Intrapartum Fever
- Antibiotic treatment should be initiated promptly when fever occurs, as acetaminophen may not be effective in reducing maternal temperature 2, 4.
- Reducing the duration of fetal exposure to intrapartum fever does not prevent known adverse neonatal outcomes, and therefore, intrapartum fever is not an indication for cesarean delivery to interrupt labor 2.
- Clinicians should be prepared for the increased risk of postpartum hemorrhage and have uterotonic agents on hand at delivery to prevent delays in treatment 2.