Obstetrical, neonatal and microbiological outcomes in laboring women with isolated fever versus suspected intraamniotic infection

Abstract

The American College of Obstetricians and Gynecology recommends considering antibiotic administration for isolated intrapartum fever, but does not define the regimen. We compared obstetrical, neonatal, and microbiological outcomes between women with isolated intrapartum fever and women with suspected intraamniotic infection. This 10-year retrospective study included all laboring women with singleton gestation and body temperature ≥38.0°C, with or without other evidence of infection. Women with isolated intrapartum fever received intravenous ampicillin, while women with suspected intraamniotic infection received intravenous ampicillin plus gentamicin. The primary outcome was endometritis occurrence. Secondary outcomes comprised: 1. Maternal culture results including: positive placental and blood cultures. 2. Maternal and neonatal clinical outcomes. In total, 458 women met the inclusion criteria. Among women with isolated intrapartum fever (n=227) compared to women with suspected intraamniotic infection (n=231), incidences were higher of postpartum endometritis (8.8% vs 3.8%, p=0.03) (table 1) and early-onset neonatal sepsis (4.4% vs. 0.4%, p=0.005) (figure 1); and rates were higher of positive placental cultures (63.9% vs. 46.3%, p< 0.001), especially ampicillin-resistant E. coli (48.9% vs. 35.4%, p=0.033). The rate of Group B streptococci positive placental cultures was similar between the groups. Women with isolated intrapartum fever, who were treated with ampicillin only, had worse maternal and neonatal outcomes than women with suspected intraamniotic infection who received ampicillin and gentamicin. Administration of ampicillin as a sole agent might promote the growth of ampicillin-resistant Enterobacteriaceae, especially E. coli, in placental cultures, and might result in endometritis and early-onset neonatal sepsis. The combined treatment with ampicillin and gentamicin that is given to women with suspected intraamniotic infection should be considered also for women with isolated intrapartum fever.View Large Image Figure ViewerDownload Hi-res image Download (PPT)