Fever In Pregnant Women Research Articles

Infections in Pregnancy

Abstract Infections in pregnant women tend to be more severe and pose unique treatment challenges. After all, the well-being of two individuals is at stake. Screening all pregnant women in early pregnancy for bacteriuria is recommended. Pyelonephritis and puerperal sepsis should be managed aggressively with appropriate empiric antibiotic choices. Increasing resistance in Enterobacterales is the complicating treatment of both these illnesses in the Indian setting. Influenza can lead to serious maternal and fetal outcomes; early empiric antiviral therapy and universal maternal vaccination are important. Dengue is an important cause of fever in pregnant women and can complicate vaginal and operative delivery due to thrombocytopenia. Falciparum malaria can now be treated with artemisinin-based combination therapy (ACT) in all trimesters. The drug of choice for scrub typhus is azithromycin; a combination of doxycycline and azithromycin can be considered in very severe disease. Treatment of both drug-sensitive and drug-resistant tuberculosis in pregnancy is similar to the nonpregnant. Safety data relating to bedaquiline and delamanid from animal models and cohort studies are reassuring.

Seroepidemiology of Lassa virus in pregnant women in Southern Nigeria: A prospective hospital-based cohort study.

There is limited epidemiological evidence on Lassa fever in pregnant women with acute gaps on prevalence, infection incidence, and risk factors. Such evidence would facilitate the design of therapeutic and vaccine trials and the design of control programs. Our study sought to address some of these gaps by estimating the seroprevalence and seroconversion risk of Lassa fever in pregnant women. We conducted a prospective hospital-based cohort between February and December 2019 in Edo State, Southern Nigeria, enrolling pregnant women at antenatal clinic and following them up at delivery. Samples were evaluated for IgG antibodies against Lassa virus. The study demonstrates a seroprevalence of Lassa IgG antibodies of 49.6% and a seroconversion risk of 20.8%. Seropositivity was strongly correlated with rodent exposure around homes with an attributable risk proportion of 35%. Seroreversion was also seen with a seroreversion risk of 13.4%. Our study suggests that 50% of pregnant women were at risk of Lassa infection and that 35.0% of infections might be preventable by avoiding rodent exposure and conditions which facilitate infestation and the risk of human-rodent contact. While the evidence on rodent exposure is subjective and further studies are needed to provide a better understanding of the avenues of human-rodent interaction; public health measures to decrease the risk of rodent infestation and the risk of spill over events may be beneficial. With an estimated seroconversion risk of 20.8%, our study suggests an appreciable risk of contracting Lassa fever during pregnancy and while most of these seroconversions may not be new infections, given the high risk of adverse outcomes in pregnancy, it supports the need for preventative and therapeutic options against Lassa fever in pregnancy. The occurrence of seroreversion in our study suggests that the prevalence obtained in this, and other cohorts may be an underestimate of the actual proportion of women of childbearing age who present at pregnancy with prior LASV exposure. Additionally, the occurrence of both seroconversion and seroreversion in this cohort suggests that these parameters would need to be considered for the development of Lassa vaccine efficacy, effectiveness, and utility models.

"Prevalence of Typhoid Fever in Pregnant Women of District Mardan Pakistan"

"Prevalence of Typhoid Fever in Pregnant Women of District Mardan Pakistan"

Fever During Pregnancy: Etiology and Fetomaternal Outcomes.

PurposeEtiological spectrum of fever in pregnant women and its impact on fetomaternal outcomes were studied. MethodsThis was a hospital-based prospective study, conducted over 12 months. All pregnant women with fever were screened and detailed etiological evaluation carried out. Maternal and foetal outcomes were noted. ResultsOne hundred and eighty-one pregnant women with fever were included. Common causes were dengue 44 (24.3%), hepatitis E 26 (14.4%) and urinary tract infection (UTI) 22 (12.2%). Mosquito-borne diseases accounted for the highest burden 61 (33.7%). Second most common were diseases transmitted by feco-oral route 46 (25.4%). Maternal deaths occurred in 29 (16%) patients. Common causes of death were hepatitis E infection in 9 of 26 (34.6%) cases, dengue in 7 of 44 (15.9%) and tuberculosis in 5 of 11 (45.5%) cases. ConclusionDengue, hepatitis E and UTI were the most common causes of fever during pregnancy. Most cases were caused by vector- and water-borne diseases and thus potentially preventable. Overall maternal mortality was 16%.

Risk Factors and Safety Analyses for Intrapartum Fever in Pregnant Women Receiving Epidural Analgesia During Labor.

BackgroundWe aimed to explore the factors leading to epidural-related maternal fever and the influence of intrapartum fever on neonates.Material/MethodsA retrospective analysis was performed on data from pregnant women who received epidural analgesia during labor. The primary aim was to determine the influence of epidural labor analgesia on the incidence of intrapartum fever in pregnant women. The secondary aim was to determine the influence of intrapartum fever on neonates.ResultsLogistic regression analysis showed that premature rupture of membranes (OR=2.008, 95% CI: 1.551–2.600), vaginal examination performed more than 6 times (OR=1.681, 95% CI: 1.286–2.197), long duration of labor (OR=1.090, 95% CI: 1.063–1.118), and long time from rupture of membranes to delivery (OR=1.048, 95% CI: 1.010–1.087) were all risk factors for intrapartum fever in pregnant women with epidural labor analgesia. Regarding the secondary research outcome, the incidence of intrapartum fever was significantly associated with the number of neonates with Apgar score of 10 delivered from pregnant women with epidural labor analgesia (P<0.05). There was no statistically significant difference in the transfer rate of newborns to the Neonatal Intensive Care Unit (NICU) (P>0.05).ConclusionsPremature rupture of membranes, vaginal examination performed more than 6 times, long duration of labor, and long time from rupture of membranes to delivery are all factors raising the risk of fever during epidural labor analgesia. Although intrapartum fever in the mothers had a significant influence on the number of neonates with Apgar score of 10, it did not affect the outcome of neonates in terms of NICU transfer rate.

Causes of fever in pregnant women with acute undifferentiated fever: a prospective multicentric study.

The etiologies of undifferentiated fever in pregnant women have not been studied thoroughly. Because of its non-specific presentation but severe prognosis, listeriosis is often suspected in this setting, but in most cases not confirmed. We studied the causes of undifferentiated fever in pregnant women who received preemptive listeriosis treatment. We conducted from November 1, 2011, to June 30, 2013, a prospective multicentric observational cohort study of pregnant women referred to obstetrical wards with undifferentiated fever and who received listeriosis preemptive treatment. Clinical and biological features, treatment, outcome, and final diagnosis were collected. We enrolled 103 febrile pregnant women. A cause was identified in 77/103 (75%): viral infection in 52/103 (50%, influenza in 21 (20%)), bacterial infection in 22 (21%, including 16 pyelonephritis (16%) and 3 pneumonias (3%)), and TORCH infection in 3 (3%, varicella, toxoplasmosis, and cytomegalovirus primo-infections, n=1, each). Viral infections collected during influenza outbreaks (December-March) accounted for 43/57 (75%) cases. Two fetal losses were reported in the context of febrile pneumonia. Final diagnoses required adapting medical care in 46/77 (60%) of cases, for bacterial, influenza, or TORCH infections. A large array of benign to potentially severe infections manifests as acute undifferentiated fever in pregnant women, requiring careful repeated evaluation.

Sheehan’s syndrome in a dengue parturient

Dengue fever is a mosquito borne arboviral infection which is a major health problem worldwide. Complications vary widely and become critical mostly during defervescence period. Dengue fever in pregnant women can cause variety of obstetric and neonatal complications. Sheehan’s syndrome (SS) is a parturition-related pituitary disease resulting from severe postpartum haemorrhage and can present with varying degrees of pituitary insufficiency. Emergency anaesthetic management of a dengue parturient and SS which developed subsequently, secondary to profuse intrapartum bleeding is discussed.

The Aetiologies and Impact of Fever in Pregnant Inpatients in Vientiane, Laos.

IntroductionLaos has the highest maternal mortality ratio in mainland Southeast Asia and a high incidence of infectious diseases. Globally, malaria has been the pathogen most intensively investigated in relation to impact on pregnancy, but there has been relatively little research on the aetiology and impact of other diseases. We therefore aimed to determine the causes and impact of fever in pregnant women admitted to two central hospitals in Vientiane City, Lao PDR (Laos).Materials and MethodsThis hospital-based prospective study was conducted in Mahosot Hospital and the Mother and Child Hospital, Vientiane, between 2006 and 2010, with the aim to recruit 250 consenting pregnant women admitted with tympanic temperature ≥37.5°C. Primary outcome was the cause of fever and secondary outcomes were pregnancy outcomes. Specific investigations (culture, antigen, molecular and serological tests) were performed to investigate causes of fever. After discharge, all pregnant women were asked to return for review and convalescence serum on day 10–14 and were monitored until delivery.Principle findings250 pregnant women were recruited to this study between February 2006 and November 2010. Fifty percent were pregnant for the first time. Their median (range) gestational age on admission was 24 (4–43) weeks. The median (range) tympanic admission temperature was 38.5°C (37.5–40.5°C). Fifteen percent of patients stated that they had taken antibiotics before admission. Headache, myalgia, back pain and arthralgia were described by >60% of patients and 149 (60%) were given a laboratory diagnosis. Of those with confirmed diagnoses, 132 (53%) had a single disease and 17 (7%) had apparent mixed diseases. Among those who had a single disease, dengue fever was the most common diagnosis, followed by pyelonephritis, scrub typhus, murine typhus and typhoid. Patients were also diagnosed with tuberculosis, appendicitis, Staphylococcus aureus septicemia, leptospirosis, Japanese encephalitis virus infection and Plasmodium falciparum malaria. Severe consequences, including maternal death, miscarriage, stillbirth, low birth weight and preterm birth, were found among 28 (78%) mothers with dengue fever, rickettsioses and typhoid.ConclusionFevers other than malaria, such as dengue, pyelonephritis, rickettsioses and typhoid are common causes of fever during pregnancy in the Asian tropics. Further investigations of their impact in the community on maternal death, fetal loss, vertical transmission, low birth weight and preterm birth are needed.

Misoprostol-Induced Fever and Genetic Polymorphisms in Drug Transporters SLCO1B1 and ABCC4 in Women of Latin American and European Ancestry

Misoprostol, a prostaglandin analogue used for the treatment of postpartum hemorrhage and termination of pregnancy, can cause high fevers. Genetic susceptibility may play a role in misoprostol-induced fever. Body temperature of women treated with misoprostol for termination of pregnancy in the UK (n = 107) and for postpartum hemorrhage in Ecuador (n = 50) was measured. Genotyping for 33 single nucleotide polymorphisms in 15 candidate genes was performed. Additionally, we investigated the transport of radiolabeled misoprostol acid across biological membranes in vitro. The ABCC4 single nucleotide polymorphism rs11568658 was associated with misoprostol-induced fever. Misoprostol acid was transported across a blood-brain barrier model by MRP4 and SLCO1B1. Genetic variability in ABCC4 may contribute to misoprostol-induced fever in pregnant women. Original submitted 21 January 2015; Revision submitted 24 April 2015.

Temperature imbalance and fever

The ability to have a body temperature that is independent of environment temperature is evolutionary acquisition. Thanks to him, organisms can control the intensity of metabolism to increase body temperature. Homoiothermic animals can maintain an optimum body temperature via the heat transfer into the environment. An optimal level of temperature is necessary for activity of most enzymes, the implementation of metabolic reactions in cells. The viscosity of blood and extracellular fluids, the surface tension of the surfactant, swelling colloids of the interstitial space depend on the temperature inside. The excitation of cells, muscle contraction, secretion, absorption, locomotor activity and phagocytic properties of neutrophils also depend on the temperature of the tissues. Fever is pathological process a temporary increasing of body temperature for homoiothermal animals and humans. The process starts due to cytokines exogenous and endogenous origin. Cytokines rebuild the system of thermoregulation. Fever is protective response to damaged but may be redundant. Tachycardia at a fever promotes arrhythmias and may be complicated by the development of acute heart failure. Critical temperature decrease with profuse sweating can cause collapse. Fever in pregnant women in the early stages of placentation provokes violations and defects of the neural tube of the embryo. Fever leads to accumulation of ketonic substances in the blood due to incomplete lipolysis. Ketoacidosis with fever in young patients is the cause of hyperthermic convulsions. The negative effects of fever forced to resort to antipyretic therapy and measures to increase heat dissipation.

Q fever and spontaneous abortion

Q fever, caused by Coxiella burnetii, may result in abortions in infected animals and pregnant women. However, the role that Q fever plays in spontaneous abortions is still unknown. This study examined the association between Q fever serology and abortion in a region where Q fever is endemic. A case–control population-based study was conducted in General Yagüe Hospital (Burgos area, Spain) between June 2009 and July 2010. A total of 801 samples from 500 pregnant women were tested, of whom 273 had a spontaneous abortion and 227 gave birth. IgG and IgM antibody titres against Q fever were determined in their two phases (I and II) by immunofluorescence assay. Seropositivity (phase I IgG ≥1:16 or phase II IgG ≥1:80) was detected in 88/273 (32.2%) cases and 53/227 (23.3%) controls; p <0.01, OR 1.5, 95% CI 1.0–2.3. Seropositivity for both phases of IgG, compatible with recent or persistent infection, was detected in 55 (20.1%) vs 22 (9.7%); p <0.001, OR 2.3, 95% CI 1.3–3.9. High phase II IgG antibodies compatible with active or recent infection (titres ≥1:160) were detected in 27 (9.6%) vs 7 (3.1%); p <0.002, OR 3.4, 95% CI 1.4–8.0, respectively. Q fever was diagnosed in 14 (5.1%) cases. The risk of abortion associated with serological markers of active or recent Q fever in pregnant women was measurable and noticeable in this population, and accounted for 12% (95% CI 4–21%).

Clinical and epidemiological aspects of Crimean-Congo hemorrhagic fever in pregnant women in South Kazakhstan

Clinical and epidemiological aspects of Crimean-Congo hemorrhagic fever in pregnant women in South Kazakhstan

Cost-effectiveness of a screening strategy for Q fever among pregnant women in risk areas: a clustered randomized controlled trial

BackgroundIn The Netherlands the largest human Q fever outbreak ever reported in the literature is currently ongoing with more than 2300 notified cases in 2009. Pregnant women are particularly at risk as Q fever during pregnancy may cause maternal and obstetric complications. Since the majority of infected pregnant women are asymptomatic, a screening strategy might be of great value to reduce Q fever related complications. We designed a trial to assess the (cost-)effectiveness of a screening program for Q fever in pregnant women living in risks areas in The Netherlands.Methods/designWe will conduct a clustered randomized controlled trial in which primary care midwife centres in Q fever risk areas are randomized to recruit pregnant women for either the control group or the intervention group. In both groups a blood sample is taken around 20 weeks postmenstrual age. In the intervention group, this sample is immediately analyzed by indirect immunofluorescence assay for detection of IgG and IgM antibodies using a sensitive cut-off level of 1:32. In case of an active Q fever infection, antibiotic treatment is recommended and serological follow up is performed. In the control group, serum is frozen for analysis after delivery. The primary endpoint is a maternal (chronic Q fever or reactivation) or obstetric complication (low birth weight, preterm delivery or fetal death) in Q fever positive women. Secondary aims pertain to the course of infection in pregnant women, diagnostic accuracy of laboratory tests used for screening, histo-pathological abnormalities of the placenta of Q fever positive women, side effects of therapy, and costs. The analysis will be according to the intention-to-screen principle, and cost-effectiveness analysis will be performed by comparing the direct and indirect costs between the intervention and control group.DiscussionWith this study we aim to provide insight into the balance of risks of undetected and detected Q fever during pregnancy.Trial registrationClinicalTrials.gov, protocol record NL30340.042.09.

Q Fever during Pregnancy

Q fever is a worldwide zoonosis caused by Coxiella burnetii. Q fever may be present as an acute or a chronic infection and can be reactivated during subsequent pregnancies. Although its exact prevalence remains unknown, it is likely that the number of cases of Q fever in pregnant women is underestimated. During pregnancy, the illness is likely to be asymptomatic, and diagnosis is based on serology. Acute infection results in appearance of IgM and IgG antibodies mainly directed against the avirulent form of C. burnetii (phase II). Chronic Q fever results in particularly high level of IgG and IgA antibodies directed against both virulent (phase I) and avirulent (phase II) forms of the bacterium. Q fever may result in adverse pregnancy outcome, including spontaneous abortion, intrauterine growth retardation, oligoamnios, intrauterine fetal death (IUFD), and premature delivery. Obstetric complications occur significantly more often as C. burnetii infects the patient at an early stage of her pregnancy. Occurrence of IUFD is correlated with the presence of placental infection by C. burnetii and might be the consequence of direct infection of the fetus. The mother is exposed to the risk of chronic Q fever and endocarditis with potential fatal evolution. Long-term cotrimoxazole therapy prevents from placental infection, IUFD, and maternal chronic Q fever. Such treatment should be used to treat pregnant women with Q fever. Women with previous history of Q fever should have a regular serological follow up. Obstetricians' knowledge about Q fever must be improved.

Etiology of Fever in Pregnant Women in Kathmandu, Nepal

Background: To study the incidence and etiology of fever in pregnancy. Methods: Prospective descriptive study conducted over a period of 24 months from September 2005 to August 2007 in the department of Obstetric and Gynecology, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal. All the admitted pregnant women with fever ≥100.4 °F (≥38 °C) were enrolled in the study after taking verbal consent. They were investigated and managed according to the hospital protocol. Complete blood count, urine for routine, microscopy, culture and sensitivity, blood culture for Salmonella, Widal test, and blood for malarial parasite were routinely sent for all the cases. Tests like liver function test, AFB staining and culture were done whenever it was thought to be necessary. Result: Total 82 cases of pregnancy with fever were admitted during the study period which accounted for 3.2% of the total pregnancy related admission. Common causes of fever were Urinary tract infection (43.9%), Enteric fever (23.1%) and viral hepatitis (8.53%). Chicken pox (1.2%), Mastitis (1.2%) and tuberculosis (1.2%) were the uncommon etiology. Fever with flu like symptoms without specific diagnosis was present in 20.73% of the cases. Conclusion: Urinary tract infection and enteric fever were the most common cause of fever during pregnancy.Definitve diagnosis was not made in large number of cases due to limited diagnostic facilities for viral infections.

A case of pregnancy complicated by blackwater fever and Bacillus coli pyelitis

A case of pregnancy complicated by blackwater fever and B. coli pyelitis is described. Full records of periodic haemoglobin estimations, blood counts, urine analyses, and blood urea estimations are given, from which may be seen the severity of the haemolyses, the consequent changes in the blood picture, the effects of blood transfusions and the progress of the B. coli infection. The results of a renal efficiency test are recorded. Attention is drawn to the apparent rarity of the occurrence of blackwater fever in pregnant women; and it is suggested as an explanation of this that there may be, in the blood of pregnant women, an increase of haemolytic bodies of sufficient amount to prevent the development of blackwater fever. The drip-transfusion of 207 ozs. of blood, including 20 ozs. from the abdomen of a case of ruptured ectopic gestation, is described. As far as we are aware, this is the first record of blood from such an unusual source having been used in a case of blackwater fever, or, indeed, for any condition apart from the auto-transfusion of the original owner. Several attacks of precordial pain are described, with the result of an electrocardiogram. The occurrence of three attacks of erythema with oedema are recorded. The treatment of the malarial infection with atebrin, and of the B. coli infection with mandelic acid and proseptacine, are given. The occurrence of a Staphylococcus aureus furunculosis is described, together with the treatment adopted.

Studies in the Transmission of Sensitization Fromm Other to Child in Human Beings

Summary Five cases of asthma and five of hay fever in pregnant women were studied by the Prausnitz-Küstner method as to the passage of antibodies through the placenta from mother to child. In each case the ability of the mother's serum, while she was carrying the child, to give a local passive transfer to a normal individual was established, in most cases with the serum diluted 1:40 and in 1 case as high as 1:320. In no case could similarproperties be shown in the undiluted cord blood or the undiluted child's blood.