Maternal Intrapartum Fever Research Articles

The relationship between epidural analgesia and intrapartum maternal fever and the consequences for maternal and neonatal outcomes: a prospective observational study

Aim To use continuous real-time monitoring of maternal core body temperature during labor and investigate the association between epidural analgesia, intrapartum maternal fever, and maternal and neonatal outcomes. Methods Among 201 pregnant women attending our institution for a vaginal in-hospital delivery, 159 women received epidural analgesia and 42 women did not receive epidural analgesia. Women’s core body temperature was continuously monitored for the duration of labor using a smartphone/iPad-connected wireless thermometer positioned in an axilla. The primary outcome was a change in maternal core body temperature during labor. Among women receiving epidural analgesia, maternal and neonatal outcomes were compared in women who developed an intrapartum fever and those who had no intrapartum temperature elevation. Results Of the women receiving epidural analgesia, 26.4% (n = 42/159) developed intrapartum fever ≥38 °C compared to 7.1% (n = 3/42) of women not receiving epidural analgesia. Among those receiving epidural analgesia, women who developed intrapartum fever had a significantly longer first stage of labor and a higher incidence of cesarean section, assisted vaginal delivery, intrapartum hemorrhage, and turbid amniotic fluid compared to women with no intrapartum temperature elevation. Neonates of women who developed intrapartum fever had lower 1- and 5-min Apgar scores compared to neonates of women with no intrapartum temperature elevation; however, the difference was not significant. Conclusion This study used a precise and accurate method to monitor core body temperature among women receiving epidural analgesia. Results showed that the use of epidural analgesia during labor was associated with intrapartum maternal fever in all stages of labor. Fever after epidural analgesia was associated with adverse maternal outcomes, independent of neonatal complications.

Randomized control trial of intravenous acetaminophen for reduction of intrapartum maternal fever

Intravenous acetaminophen reaches a higher mean peak plasma concentration than oral acetaminophen in a shorter period of time. The favorable pharmacokinetics of intravenous acetaminophen may be beneficial for treating intrapartum maternal fever. The primary objective was to compare intravenous and oral acetaminophen in time to defervescence (temperature <38°C). The secondary objective was to compare intravenous and oral acetaminophen in the percentage of participants being afebrile and percent reduction in maternal temperature 30 minutes after administration of first dose. Other outcomes evaluated were histopathological placental findings; neonatal outcomes; oxidative stress; and levels of RANTES, interferon-δ, interleukin 1β, interleukin 2, interleukin 4, interleukin 6, interleukin 8, interleukin 10, interleukin 13, and tumor necrosis factor-α in maternal and neonatal blood. This was a randomized, comparator-controlled, double-dummy, double-blind clinical trial. At the onset of intrapartum fever ≥38°C, patients ≥36 weeks' gestation were either randomized to the control or experimental study arm. Patients in the control arm received 1000 mg of oral acetaminophen capsules and an intravenous placebo resembling intravenous acetaminophen. Patients randomized to the experimental arm received 1000 mg of intravenous acetaminophen and oral placebo capsules resembling acetaminophen. Maternal temperatures and fetal heart rates were recorded at consecutive intervals following administration of the first dose of acetaminophen. Maternal blood, collected at the onset of fever and after delivery, and neonatal cord blood collected at delivery were evaluated for oxidative stress (glutathione levels), levels of RANTES and cytokines (interferon-δ, interleukin 1β, interleukin 2, interleukin 4, interleukin 6, interleukin 8, interleukin 10, interleukin 13, and tumor necrosis factor-α). Placentas were collected for pathologic review. A P value of <.05 was considered statically significant. A total of 121 patients (55 in the intravenous and 66 in the oral group) were recruited from December 1, 2016, to February 28, 2018. Patient demographics and intrapartum factors were similar between both arms. The intravenous group showed a mean time of 54.86 minutes (95% confidence interval, 20.57-39.43) to defervescence vs 52.58 minutes (95% confidence interval, 16.58-43.42) in the oral group (P=.71). In addition, intravenous and oral acetaminophen showed similar results in percentage of patients being afebrile and percent reduction in maternal temperature 30 minutes after administration of the first dose. Histopathological findings, neonatal outcomes, oxidative stress markers, and RANTES and cytokine levels were not statistically significant between intravenous and oral acetaminophen groups. Intravenous acetaminophen did not demonstrate a higher efficacy than oral acetaminophen in treating intrapartum maternal fever. Select patients may benefit from intravenous acetaminophen for treatment of intrapartum fever, including those who cannot tolerate oral medication.

Intra-amniotic Infection

Intra-amniotic Infection

Potential impact of epidural labor analgesia on the outcomes of neonates and children.

This review summarizes recent evidences regarding the potential influences of epidural labor analgesia (ELA) on the outcomes of neonates and children. Terms and relevant words including “ELA,” “ELA and neonatal outcomes,” “ELA and children's development,” and “ELA and children's neurocognitive development” were used to search articles published in PubMed database up to October 2019. Original articles and reviews regarding potential influences of ELA on neonates and children were identified. Relevant references of the selected articles were also screened. The anesthetics used during ELA can be absorbed, enter the fetus, and produce neonatal depression; however, these effects are less severe than those during systematic opioid analgesia. The impact of anesthetic exposure during ELA on children's neurodevelopment has not been fully studied, but would be mild if any. ELA increases the risk of intrapartum maternal fever; the latter may be harmful to neonatal outcomes. The use of ELA may increase birth injury by increasing instrumental delivery, although long-term adverse events are rare. On the other hand, ELA may reduce maternal depression and, thus, produce favorable effects on neurocognitive development in childhood; but evidences are still lacking in this aspect. ELA may produce both favorable and unfavorable effects on neonates and children. These effects should be discussed with parturient women before making decisions. The potential harmful effects should be carefully managed. The overall impacts of ELA on neonatal and children's outcomes need to be studied further.

Neonate Born to a Mother with a Diagnosis of Suspected Intra-Amniotic Infection versus COVID-19 or Both

A diagnosis of intra-amniotic infection is typically made based on clinical criteria, including maternal intrapartum fever and one or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia. The diagnosis can also be made in patients with an isolated fever of 39°C, or greater, without any other clinical risk factors present. Coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, has been noted to have varying signs and symptoms over the course of the disease including fever, cough, fatigue, anorexia, shortness of breath, sputum production, and myalgia. In this report, we detail a case of a newborn born to a mother with a clinical diagnosis of intra-amniotic infection with maternal fever and fetal tachycardia, who was then found to be SARS-CoV-2 positive on testing. Due to the varying presentation of COVID-19, this case illustrates the low threshold needed to test mothers for SARS-CoV-2 in order to prevent horizontal transmission to neonates and to healthcare providers.

Double-Balloon Device for 6 Compared With 12 Hours for Cervical Ripening: A Randomized Controlled Trial.

To evaluate whether removal of a double-balloon device for cervical ripening for 6 compared with 12 hours in women with an unfavorable cervix will result in a shorter time to delivery, similar cervical ripening, and without affecting cesarean delivery rate. In a prospective randomized trial, cervical ripening was performed using a double-balloon device. Women were randomized to removal of the device after 6 compared with 12 hours. Primary outcome was time to delivery. Secondary outcomes included mode of delivery, Bishop score, and maternal and neonatal adverse outcomes. A sample size of 100 nulliparous and 100 parous women was required assuming a 95% CI, power of 80%, and mean decrease of 6 hours to delivery between the groups. From March 2017 through February 2019, 688 women were screened, 243 were found eligible, and 197 were randomized as follows: nulliparous cohort (n=101): removal after 6 hours (n=48) compared with removal after 12 hours (n=53); parous cohort (n=96): removal after 6 hours (n=49) compared with removal after 12 hours (n=47). Insertion-to-delivery interval was significantly shorter in the 6-hour group for both nulliparous (25.6±12.8 hours vs 31.4±15.2 hours, P<.04; mean difference 5.8, 95% CI 0.2-11.3), and parous cohorts (18.0±6.8 hours vs 22.6±8.2 hours, P=.003; mean difference 4.7, 95% CI 1.6-7.7). Bishop score change and cesarean delivery rate were similar between groups regardless of parity. The 12-hour group in the combined cohort was associated with higher rates of maternal intrapartum fever (2% vs 10%, P=.02; odds ratio 5.3, 95% CI 1.1-24.8). Insertion-to-delivery interval is shorter after 6 compared with 12 hours for both nulliparous and parous women. Cervical ripening with a double-balloon device may be achieved in 6 hours. The longer time was associated with a higher rate of intrapartum fever. Six hours should be considered as standard placement time for double-balloon catheters. ClinicalTrials.gov, NCT03045939.

Neonatal Cerebral Sinovenous Thrombosis: A Rare Case Report and Literature Review

Neonatal cerebral sinovenous thrombosis is a rare and potentially life-threatening disorder associated with various longterm neurological deficits. The pathogenesis of cerebral sinovenous thrombosis in neonates is still unclear. Many potential risk factors have been identified, such as gestational or delivery complications or neonatal comorbid conditions including dehydration, sepsis, or cardiac defects. A correct diagnosis is often delayed due to the subtle presentation of the disorder, leading to delayed treatment with poor outcomes. Herein, we report a preterm female neonate who was born only with the presentation of intrapartum maternal fever. Routine brain sonography showed intraventricular hemorrhage. In a further study, brain magnetic resonance imaging revealed neonatal multiple sinovenous thrombosis. To prevent potential thrombosis development and ameliorate possible thrombosis-related problems, the infant immediately received anticoagulation therapy. At the 3-month follow-up, developmental milestones were within the normal range, and the follow-up brain MRI scans also showed normal results. In conclusion, early recognition and proper treatment may yield a better prognosis for neonatal cerebral sinovenous thrombosis, especially when patients exhibit any possible risk factors, which should alert healthcare professionals.

Remifentanil patient-controlled versus epidural analgesia on intrapartum maternal fever: a systematic review and meta-analysis

BackgroundIntravenous remifentanil patient-controlled analgesia (RPCA) is an alternative for epidural analgesia (EA) in labor pain relief. However, it remains unknown whether RPCA is superior to EA in decreasing the risk of intrapartum maternal fever during labor.MethodsAccording to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis was performed by searching PubMed, EMBASE and the Cochrane Central Register of Controlled Trials from inception to April 2019. All randomized controlled trials (RCTs) investigating the risk of intrapartum maternal fever with RPCA compared with EA alone or EA in combination with spinal analgesia during labor were included.ResultsA total of 825 studies were screened, and 6 RCTs including 3341 patients were identified. Compared with EA, RPCA was associated with a significantly lower incidence of intrapartum maternal fever (risk ratio [RR] 0.48, P = 0.02, I2 = 49%) during labor analgesia. After excluding 2 trials via the heterogeneity analysis, there was no difference in the incidence of intrapartum fever between patients receiving RPCA and those receiving EA. Satisfaction with pain relief during labor was lower in the RPCA group than that in the EA group (− 10.6 [13.87, − 7.44], P < 0.00001, I2 = 0%). The incidence of respiratory depression was significantly greater in the RPCA group than that in the EA group (risk ratio 2.86 [1.65, 4.96], P = 0.0002, I2 = 58%). The incidence of Apgar scores < 7 at 5 min in the RPCA group was equivalent to that in the EA group.ConclusionThere is no solid evidence to illustrate that the incidence of intrapartum maternal fever is lower in patients receiving intravenous RPCA than in patients receiving EA.

Concerned topics of epidural labor analgesia: labor elongation and maternal pyrexia: a systematic review.

Objective:Labor is a complex process and labor pain presents challenges for analgesia. Epidural analgesia (EA) has a well-known analgesic effect and is commonly used during labor. This review summarized frequently encountered and controversial problems surrounding EA during labor, including the labor process and maternal intrapartum fever, to build knowledge in this area.Data sources:We searched for relevant articles published up to 2019 in PubMed using a range of search terms (eg, “labor pain,” “epidural,” “analgesia,” “labor process,” “maternal pyrexia,” “intrapartum fever”).Study selection:The search returned 835 articles, including randomized control trials, retrospective cohort studies, observational studies, and reviews. The articles were screened by title, abstract, and then full-text, with a sample independently screened by two authors. Thirty-eight articles were included in our final analysis; 20 articles concerned the labor process and 18 reported on maternal pyrexia during EA.Results:Four classic prospective studies including 14,326 participants compared early and delayed initiation of EA by the incidence of cesarean delivery. Early initiation following an analgesia request was preferred. However, it was controversial whether continuous use of EA in the second stage of labor induced adverse maternal and neonatal outcomes due to changes in analgesic and epidural infusion regimens. There was a high incidence of maternal pyrexia in women receiving EA and women with placental inflammation or histologic chorioamnionitis compared with those receiving systemic opioids.Conclusions:Early EA (cervical dilation ≥1 cm) does not increase the risk for cesarean section. Continuous epidural application of low doses of analgesics and programmed intermittent epidural bolus do not prolong second-stage labor duration or impact maternal and neonatal outcomes. The association between EA and maternal pyrexia remains controversial, but pyrexia is more common with EA than without. A non-infectious inflammatory process is an accepted mechanism of epidural-related maternal fever.

336: Effects of intrapartum fever on umbilical artery pH, lactate and base excess

Both elevated umbilical artery (UA) lactate and maternal fever have been independently associated with poor neonatal outcomes, including acidosis, hypoxic-ischemic encephalopathy, cerebral palsy, etc. We sought to determine whether maternal intrapartum fever had an impact on neonatal metabolic status, as determined by UA pH, lactate and base-excess. In this prospective cohort study, UA cord blood samples were collected from vaginal and cesarean singleton deliveries that occurred between June and August 2019 at a tertiary care center. UA pH, lactate and base excess were then assessed using a GEM 4000 blood gas analyzer. Presence of maternal intrapartum fever (temperature > 31.5°C or 100.5°F during labor) were determined from medical records. 205 samples were included in the study. There was no statistically significant difference in UA pH between births complicated by maternal fever (n=9, mean pH 7.20) and those not complicated by fever (n=196, pH 7.23, p=0.328). However, the mean UA lactate in the maternal fever group was significantly higher than that of the non-fever group (6.04 mmol/L vs. 4.47 mmol/L, respectively, p=0.002). Mean base excess was also significantly lower in the maternal fever group (-7.87 mEq/L vs. -5.45 mEq/L in the non-fever group, p=0.0142). Though UA pH did not differ between the groups, neonates born to mothers with intrapartum fevers were found to have significantly higher UA lactate and lower base excess than those born to mothers who remained afebrile at delivery. This suggests the presence of fetal metabolic challenge that would not have been evident when only using UA pH as an assessment of neonatal metabolic status. Further research is needed to determine the clinical significance of these findings with respect to neonatal outcomes.

Programmed intermittent epidural bolus decreases the incidence of intra-partum fever for labor analgesia in primiparous women: a randomized controlled study.

To evaluate whether programmed intermittent epidural bolus (PIEB) reduces the incidence of maternal intra-partum fever compared with continuous epidural infusion (CEI) during labor. Parturients were randomized to receive CEI (CEI group) or PIEB (PIEB group) with 10ml per hour for epidural labor analgesia with 1500 subjects in each group. The maintaining dose of two groups is 0.08% ropivacaine with 0.4μg/ml sufentanil, with patient-controlled epidural analgesia (PCEA) dose of 5ml and lockout interval of 30min. The incidence of maternal fever, pain score, epidural sensory levels, the number and proportion of PCEA demand, anesthetics consumption, satisfaction score, neonatal Apgar scale, and maternal and neonatal side effects were recorded. It was significantly lower of the incidence of maternal fever beginning at 4h post-analgesia and continuing until delivery in the PIEB group than the CEI group (4h: 2.6% vs. 4.2%; 5h: 7.3% vs. 10.2%; delivery: 5.6% vs. 7.9%; 1h post-delivery: 3.9% vs. 6.2%; 2h post-delivery: 2.1 vs. 3.5%; total: 5.8% vs. 8.4% in PIEB and CEI, respectively). Compared with CEI group, pain scores at 3, 4, 5h post-analgesia and delivery (3h: 2 [1, 2] vs. 2 [1-3]; 4h: 2 [2, 3] vs. 3 [2-4]; 5h: 2 [2, 3] vs. 3 [2-4]; delivery: 3 [2-4] vs. 4 [3, 4] in PIEB and CEI, respectively), the number and proportion of PCEA demand (number: 0.7 ± 0.9 vs. 2.2 ± 1.9; proportion: 42.0% vs. 80.3% in PIEB and CEI, respectively), and anesthetics consumption significantly decreased in the PIEB group (Ropivacaine: 60 ± 13mg vs. 76 ± 17mg; Sufentanil: 26 ± 4mg vs. 32 ± 6mg in PIEB and CEI, respectively), without severe maternal and neonatal side effects and any difference in neonatal Apgar scale. The epidural sensory levels 2h post-analgesia (2h: 8[8, 9] vs. 9[8, 9] in PIEB and CEI) and satisfaction score (9 [9, 10] vs. 7 [6, 7] in PIEB and CEI) were significantly higher in the PIEB group compared with those in the CEI group. PIEB with 10ml of 0.08% ropivacaine and 0.4μg/ml sufentanil hourly provided a lower incidence of intra-partum fever with a better analgesic effect compared with CEI, without any severe maternal and neonatal adverse reactions.

Risk factors for group B streptococcus early-onset disease: an Italian, area-based, case-control study

Purpose: Intrapartum antibiotic prophylaxis (IAP) prevents group B streptococcus (GBS) early-onset disease (EOD). No European study evaluates the relative impact of risk factors (RFs) for EOD after a screening-based strategy and widespread IAP use We aimed to evaluate the risks of EOD in an Italian region where a screening-based strategy for preventing EOD was implemented.Materials and methods: Cases of EOD born at or above 35 weeks’ gestation were reviewed and matched with controls.Results: There were 109 cases of EOD among 532,154 live births. Most cases had negative GBS prenatal screening (56/91, 61.5%) and were unexposed to IAP (86/109, 78.9%). At multivariate analysis, GBS bacteriuria (OR = 6.99), positive prenatal screening (OR = 13.7) and maternal intrapartum fever (OR = 188.3) were associated with an increased risk of EOD, whereas intrapartum beta-lactam antibiotics were associated with a decreased risk of EOD (≥4 h: OR = 0.008; <4 h: OR = 0.04). Neonates born to nonfebrile, GBS positive pregnant women, receiving beta-lactam antibiotics had very low probability of EOD, particularly if IAP was adequate.Conclusions: GBS positive prenatal screening, GBS bacteriuria and intrapartum fever are associated with EOD. Intrapartum beta-lactam antibiotics reduce the probability of EOD in neonates born to nonfebrile mothers.

Universal versus Risk-Based Management of Unknown Group B Streptococcus Status at Term.

Objectives This article estimates and compares public health costs of universal versus risk-based intrapartum antibiotic prophylaxis (IAP) administration for women with unknown Group B streptococcus (GBS) status at term. Study Design The annual number of women in the U.S. who are: unscreened for GBS, without risk factors, delivering vaginally, multiparous, and eligible for discharge within 24 hours was estimated. Under the risk-based strategy, women and neonates were assumed to stay another day for observation and incur the cost of an additional 24-hour stay. With universal IAP administration, women delivering without complications were assumed to be discharged within 24 hours, with an incurred cost of penicillin. Results The estimated cost for the risk-based management of unscreened women at term without rupture of membranes (ROM) > 18 hours ranged from $468,886,831 to $850,556,179. Similarly, the cost of managing unscreened women without maternal intrapartum fever (MIF) ranged from $742,024,791 to $919,269,233. Alternatively, universal IAP administration costs ranged from $470,107,674 to $568,359,086.5. Cost comparisons yielded an equivalence or up to a 33.2% reduction in cost, and 36.6 to 38.2% reduction in cost for women without ROM > 18 hours and MIF, respectively. Conclusions Universal IAP may be cost saving due to the reduction in extended hospitalizations for neonates and healthy mothers.

A cohort study of the impact of epidural analgesia on maternal and neonatal outcomes.

To explore the impact of epidural analgesia on maternal and neonatal outcomes, especially the relation between epidural analgesia and intrapartum fever. A retrospective cohort study was conducted in a tertiary hospital for all deliveries from November 2017 to December 2017. A total of 506 women were divided into epidural and non-epidural group by whether to receive analgesia or not. Univariate and multivariate analyses were performed with P < 0.05 as significant. Epidural analgesia was associated with higher risk of maternal intrapartum fever (relative risk [RR] = 3.28, 95% confidence interval, 1.55-6.95), more intravenous use of antibiotics (36.66% vs 17.04%, P<0.001), longer time of second stage (58.55 ± 33.75 vs 47.39 ± 28.36 min，P = 0.001) and longer total duration of labor (790.32 ± 433.71 vs 461.33 ± 270.39 min，P<0.001), but had no influence on mode of delivery, the amount of post-partum hemorrhage or hospital stay after delivery and all the neonatal outcomes we studied. Further time effect analysis found that epidural analgesia less than 6 h did not increase the risk of intrapartum fever (RR = 1.73, P = 0.15), however, when epidural analgesia lasted over 6 h, it significantly increased the risk of fever (RR = 5.23, P<0.001) but did not increase more adverse outcomes. Having epidural anesthesia 6 h or more increases the risk of developing fever, but the prognosis of mothers and children is less affected.

Early onset sepsis calculator-based management of newborns exposed to maternal intrapartum fever: a cost benefit analysis.

To determine potential net monetary benefit of an early onset sepsis calculator-based approach for management of neonates exposed to maternal intrapartum fever, compared to existing guidelines. We performed a cost-benefit analysis comparing two management approaches for newborns >34 weeks gestational age exposed to maternal intrapartum fever. Probabilities of sepsis and meningitis, consequences of infection and antibiotic use, direct medical costs, and indirect costs for long-term disability and mortality were considered. A calculator-based approach resulted in a net monetary benefit of $3998 per infant with a 60% likelihood of net benefit in probabilistic sensitivity analysis. Our model predicted a 67% decrease in antibiotic use in the calculator arm. The absolute difference for all adverse clinical outcomes between approaches was ≤0.6%. Compared to existing guidelines, a calculator-based approach for newborns exposed to maternal intrapartum fever yields a robust net monetary benefit, largely by preventing unnecessary antibiotic treatment.

Maternal Epidural Steroids to Prevent Neonatal Exposure to Hyperthermia and Inflammation.

Epidural analgesia is associated with a fourfold increased rate of intrapartum fever. The likely pathophysiology is a noninfectious maternal inflammatory activation. Safe interventions to reduce maternal and neonatal exposures to intrapartum fever and inflammation are needed. The purpose of this study was to determine if prophylactic epidural steroids decrease fetal exposure to hyperthermia and inflammatory cytokines following epidural analgesia. This is a randomized, double-blinded, placebo controlled trial. Term nulliparous women requesting epidural analgesia received 80 mg methylprednisolone or preservative-free normal saline via the epidural catheter at placement. The primary outcome was maternal temperature >100.4°F. Secondary outcomes included fetal exposure to inflammation as assessed by cord blood interleukin-6 (IL-6) levels and rates of funisitis. Power analysis estimated a sample size requirement of 276, but new Food and Drug Administration (FDA) recommendations advising a black box warning on epidural steroids resulted in early study termination. A total of 116 subjects were enrolled: 58 treatments and 58 placebos. There was no difference in the rate of maternal intrapartum fever or cord blood IL-6 levels between treatment arms. No complications listed in the FDA warning occurred. Prophylactic epidural methylprednisolone was not effective in reducing intrapartum fever or neonatal inflammation following epidural analgesia. Alternate mechanisms and preventative strategies should be considered.

Association Between Intrapartum Magnesium Administration and the Incidence of Maternal Fever: A Retrospective Cross-sectional Study

(Anesthesiology. 2017;127:942–952) Maternal fever is associated with neonatal seizures, cerebral palsy, hypotonia, and other adverse neonatal outcomes; it complicates up to one third of all labors. Increased levels of interleukin 6 (IL-6) have been observed in maternal fever, in both inflammatory and infectious etiologies. In animals, magnesium sulfate has suppressed IL-6 induced maternal fevers and is used in humans to reduce the risk of cerebral palsy in infants. This study aimed to investigate the association between intrapartum maternal fever and maternal magnesium administration.

PIH19 - Management of Asymptomatic Term & Late Preterm Newborns Exposed to Maternal Intrapartum Fever: A Societal Cost Benefit Analysis of the Proposed “Triple I” Algorithm

PIH19 - Management of Asymptomatic Term & Late Preterm Newborns Exposed to Maternal Intrapartum Fever: A Societal Cost Benefit Analysis of the Proposed “Triple I” Algorithm

Vertical transmission of group B Streptococcus and associated factors among pregnant women: a cross-sectional study, Eastern Ethiopia.

BackgroundVertically transmitted group B Streptococcus (GBS) causes fetal and neonatal infections. However, there is limited information on the vertical transmission of GBS in low-income countries. This study, therefore, aimed to determine the rate of vertical transmission of GBS and associated factors among pregnant women in Eastern Ethiopia.Subjects and methodsA cross-sectional, facility-based study was conducted among pregnant women in Harar town, Eastern Ethiopia, from June to October, 2016. GBS positivity of pregnant women was confirmed by culture of rectovaginal swab. Vertical transmission at birth was confirmed by culture on swabs taken from the ear canal, umbilicus, axilla, groin, and nose within 6 hours after birth. Prevalence ratio (PR) along with 95% CI was estimated to examine factors associated with vertical transmission using log binomial regression analysis.ResultsOut of 231 GBS-colonized pregnant women at delivery, 104 births were identified as GBS colonized with a vertical transmission rate of 45.02% and 95% CI: 38.49, 51.68. Of 104 vertical transmission cases, 65 (62.50%) received no intrapartum antibiotic prophylaxis (IAP), 28 (26.92%) received it <4 hours before delivery, and 11 (10.58%) received it ≥4 hours before delivery. Pre-labor rupture of membranes at term (PR: 1.93; 95% CI: 1.04, 3.57), prolonged rupture of the membrane ≥18 hours (PR: 1.76; 95% CI: 1.13, 2.74), intrapartum maternal fever (PR: 1.40; 95% CI: 1.13, 1.75), and IAP received ≥4 hours (PR: 0.17; 95% CI: 0.09, 0.30) were significantly associated with vertical transmission of GBS.ConclusionThe magnitude of vertical transmission of GBS was very high. However, the rate of adequate IAP received by mothers was very low. Efforts need to be strengthened to screen pregnant women during antenatal care and IAP should be used as necessary. Furthermore, maternal vaccination may provide a feasible strategy to reduce the vertical transmission.

Double-balloon versus single-balloon catheter for cervical ripening and labor induction: A systematic review and meta-analysis.

We searched Embase, PubMed and the Cochrane Library for randomized or quasi-randomized controlled trials to compare the use of single-balloon to double-balloon catheters. The risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) was calculated using fixed-effects or random-effects models. Four studies involving a total of 793 pregnant women were included. There were no significant differences in the rate of cesarean (RR 1.09, 95% CI 0.86, 1.38; P = 0.48), or vaginal deliveries within 24 h (RR 0.94, 95% CI 0.82, 1.09; P = 0.42), the mean time to delivery (MD 0.39, 95% CI -0.90, 1.68 h; P = 0.55) or Bishop score improvement (MD 0.62, 95%CI -0.18, 1.42; P = 0.13) between the groups. Women who received the double-balloon catheter had a similar risk of maternal intrapartum fever and post-partum hemorrhage. Pain during ripening was only reported in one trial and was significantly higher with the double balloon, whereas pain during device insertion was measured in two trials: one reported no difference while the other reported significantly increased pain with the double balloon. The double-balloon and single-balloon (Foley) catheters had similar effectiveness and safety. The Foley catheter is significantly cheaper, widely available and accessible, has a longer history of use and remains the logical choice over the double-balloon catheter for cervical ripening.