237: Peripartum fever as an independent risk factor for perinatal mortality among patients undergoing cesarean delivery

Abstract

MORTALITY AMONG PATIENTS UNDERGOING CESAREAN DELIVERY TAMAR TZUR, AMALIA LEVY, GERSHON HOLCBERG, EYAL SHEINER, Soroka University Medical Center, Department of Obstetrics and Gynecology, Beer-Sheva, Israel, Ben Gurion University of the Negev, Faculty of Health Services, Epidemiology, Beer-Sheva, Israel OBJECTIVE: To identify incidence, risk factors, and outcome of peripartum fever in women undergoing cesarean delivery (CD). STUDY DESIGN: A population-based study comparing women undergoing CD who did and did not develop peripartum fever was conducted. Multiple logistic regression models were used to control for confounders. RESULTS: Out of 23,947 CDs, 4.9% (n 1,177) were complicated by fever. Independent risk factors associated with peripartum fever were placental abruption (OR 1.8; 95% CI, 1.4 –1.8), prolapse of cord (OR 1.6; 95% CI, 1.1–1.6), lack of prenatal care (OR 1.5; 95% CI, 1.2–1.5), failure to progress during the second stage of labor (OR 1.5; 95% CI, 1.2–1.5), placenta previa (OR 1.4; 95% CI, 1.04 –1.4), fetal distress (OR 1.3; 95% CI, 1.1–1.3), severe preeclampsia (OR 1.3; 95% CI, 1.05-1.7), premature rupture of membranes (OR 1.3; 95% CI, 1.1–1.6) and failure to progress during the first stages of labor (OR 1.2; 95% CI, 1.05–1.2). Urgent CD was also noted as an important risk factor for peripartum fever (OR 1.6; 95% CI 1.4-1.8; P 0.001). More women in the fever group received blood transfusions (OR 3.0; 95% CI, 2.5-3.7), experienced perinatal mortality (OR 2.5; 95%CI 1.9-3.4) and had infants with significantly lower Apgar scores at 1 min and 5 min, (OR 1.6; 95% CI 1.4-1.8 and OR 1.9; 95% CI 1.4-2.5; respectively) as compared to the comparison group. Using a multivariable analysis, with perinatal mortality as the outcome variable and controlling for important confounders such as placental abruption, non-reassuring fetal heart rate patterns etc, peripartum fever was an independent risk factor for perinatal mortality among patients undergoing CD (OR 2.1; 95% 1.6-2.7; P 0.001). Moreover, the association between peripartum fever and perinatal mortality remained significant during 3 time periods (1988-1993: OR 2.0; 95% CI, 1.1–3.9; 1994-1999: OR 2.2; 95% CI, 1.3–3.9 and 2000-2006: OR 3.3; 95% CI, 2.1–5.1). CONCLUSION: Peripartum fever is an independent risk factor for perinatal mortality among patients delivered by cesarean section.