Abstract
BackgroundFever is a well-known side effect of misoprostol, but clinically difficult to distinguish from an intra uterine infection. The aim of this study was to determine the incidence of fever in terminations of pregnancy (TOP) using misoprostol and to evaluate fever as indication of intra uterine infection.MethodsA retrospective cohort study was performed. Consecutive second trimester TOP with misoprostol between January 2008 and October 2012 were selected. We included 403 cases and determined the incidence of fever. To examine intra uterine infection as plausible cause of fever, pathological examination reports of placentas were reviewed for signs of infections.ResultsThe incidence of fever was 42%. Logistic regression showed a dose dependent association between dosage misoprostol and degree of fever (OR 1.86; 95% CI: 1.3–2.7). There was no association between fever and epidural analgesia. Fever has a sensitivity of 55% and a specificity of 58% as a marker of intra uterine infection. The positive predictive value of fever for an intra uterine infection is 4% and the negative predictive value is 98%.ConclusionAdministration of misoprostol for the indication TOP is strongly associated with fever during labor. Fever is a poor predictor of intra uterine infection in the context of TOP.
Highlights
Fever is a well-known side effect of misoprostol, but clinically difficult to distinguish from an intra uterine infection
Women were excluded for the following reasons: (1) fever before induction of labor (n = 11), (2) incomplete medical charts (n = 30) or (3) protocol violation of misoprostol dosage (n = 14)
Compared to those who did not develop fever, women with fever more often were of advanced gestational age, more often were nulliparous, had a longer induction-expulsion time, and a higher total dosage misoprostol (Table 1)
Summary
Fever is a well-known side effect of misoprostol, but clinically difficult to distinguish from an intra uterine infection. The aim of this study was to determine the incidence of fever in terminations of pregnancy (TOP) using misoprostol and to evaluate fever as indication of intra uterine infection. Approximately 10 to 15% are performed in the second trimester, defined as 12 to 28 weeks of gestation, and are mostly conducted medically. These second trimester TOPs are responsible for two-thirds of all major complications in TOPs, including. Fever as a side effect of misoprostol and fever caused by intra
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