103 Fever at 29 Weeks Pregnant Risk for Baby

J Gynecol Obstet Hum Reprod. 2020 Nov; 49(9): 101899.

Causes and consequences of fever during pregnancy: A retrospective report in a gynaecological emergency department

C. Egloff,^{a, b, d, e, ⁎} J. Sibiude,^{a, b, d, e} C. Couffignal,^{c, d, eastward} L. Mandelbrot,^{a, b, d, due east} and O. Picone^{a, b, d, eastward}

C. Egloff

^aAssistance Publique-Hôpitaux de Paris APHP.Nord, Service de gynécologie obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92701, Colombes cedex, France

^bFHU PREMA, France

^dUniversité de Paris, Paris, France

^eINSERM, IAME, UMR 1137, Paris, French republic

J. Sibiude

^aAid Publique-Hôpitaux de Paris APHP.Nord, Service de gynécologie obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92701, Colombes cedex, France

^bFHU PREMA, France

^dUniversité de Paris, Paris, France

^eINSERM, IAME, UMR 1137, Paris, French republic

C. Couffignal

^cUnité de recherche clinique Paris Nord Val de Seine, URC PNVS, France

^dUniversité de Paris, Paris, France

^eastINSERM, IAME, UMR 1137, Paris, France

L. Mandelbrot

^aAssistance Publique-Hôpitaux de Paris APHP.Nord, Service de gynécologie obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92701, Colombes cedex, French republic

^bFHU PREMA, France

^dUniversité de Paris, Paris, France

^eINSERM, IAME, UMR 1137, Paris, France

O. Picone

^aAssistance Publique-Hôpitaux de Paris APHP.Nord, Service de gynécologie obstétrique, Hôpital Louis Mourier, 178 rue des Renouillers, 92701, Colombes cedex, France

^bFHU PREMA, France

^dUniversité de Paris, Paris, France

^eINSERM, IAME, UMR 1137, Paris, France

Received 2020 May 28; Revised 2020 Aug eleven; Accepted 2020 Aug xiii.

Abstract

Objective

Fever is a very mutual reason for emergency consultation during pregnancy, and may exist associated with maternal, obstetrical and/or fetal adverse outcomes. The aim of this study was to determine the etiologies and to analyze the maternal or fetal complications of fever in pregnancy.

Study design

A retrospective unmarried eye study including all patients who consulted for fever higher up 38 °C during pregnancy in the gynecological emergency ward from Baronial 2016 to July 2017.

Results

A total of 100 meaning women who consulted for fever were included. The etiologies were mutual viral infections (37 %), flu (21 %), pyelonephritis (xi %), viral gastroenteritis (6%), chorioamnionitis (5%), other (v%). The etiology was unknown for 15 %. Fever was confirmed during consultation in 45/100 patients (45 %). Amidst patients with confirmed fever, 21/45 (47 %) were hospitalized with a median stay of three days [IQR 2–4] and 10/45(22 %) adult fetal or maternal complications. Probabilistic antibiotics were delivered for 34/45, 76 % patients. Only fourteen/45, 31 % had confirmed bacterial infections. Of the 32 patients with confirmed fever who had no etiologic diagnosis at the initial work-up in the emergency room, 19/32, 59 % received presumptive treatment with amoxicillin confronting Listeria monocytogenes. None had confirmed listeriosis, and all were probably mutual viral infections. Among all patients, the complications rate was 13 % and 22 % in the subgroup with fever confirmed at presentation.

Conclusions

This study quantifies the main etiologies and complications of fever during pregnancy. A claiming is to reduce excessive antibiotic use by improving rapid diagnosis of bacterial and viral infections. Prospective studies are needed to target patients at hazard of complications in an optimal fashion and to study new direction strategies.

Keywords: Fever, Pregnancy, Influenza, Etiology, Complications, Antibiotics

1. Introduction

Fever is i of the virtually frequent reasons for emergency consultation during pregnancy and may exist associated with significant adverse outcomes, these being maternal (sepsis, organ damages) obstetrical (miscarriage, preterm birth, chorioamnionitis) or fetal (malformations, fetal demise). However, merely one study including mainly 2d and tertiary trimester pregnant women, evaluated causes of acute undifferentiated fever and 25 % of women had no identified cause [1]. Moreover, near 12 % (IC95 8.6–sixteen.8) of patients with fever during pregnancy required hospitalization in intensive intendance unit of measurement and information technology has been shown that bacteremia is complicated by fetal loss in 10 % of cases [ii,3]. Published studies usually focus on a single etiology, such equally influenza, or pyelonephritis, and some studies focus on fever every bit a symptom during labor [[4], [5], [6]]. To our noesis, etiologies and complications of fever during pregnancy accept never been studied.

There is no recommendation nearly fever in pregnant women, merely usual intendance for undifferentiated fever is to introduce probabilistic antibiotic confronting listeria monocytogenes, responsible for overuse of antibiotics. Improving knowledge most etiology and direction of fever in pregnant women could modify antibiotics prescription, which can have consequences on public health [seven]. The importance of correctly orienting diagnosis and care is underscored by the electric current COVID-19 epidemic.

The aim of this study was to determine etiology, antibiotics prescription and maternal or fetal complications in women consulting for fever during pregnancy.

2. Methods

2.1. Report population

We conducted a retrospective single heart accomplice study, including all pregnant women who presented for fever over one year. Inclusion criteria were: any significant women consulting between August 1, 2016 and July 31, 2017 to the gynecological emergency department of the Louis Mourier infirmary (Assistance Publique des Hopitaux de Paris), a third care center, with a temperature greater than or equal to 38 °C (100.4 °F) at home or at the emergency department. Among all consultations, utilise of antipyretics before the consultation could not be comprehensively collected. We chose to include all patients who had fever, even if fever was not confirmed in the Emergency room (ER). Because this grouping was ordinarily not described in bachelor literature, the population was then analyzed in two groups: patients whose fever was confirmed in the ER vs patients whose fever was not confirmed in the ER (fever but at home). Exclusion criteria were incomplete medical records, upshot of pregnancy not known or in progress at the time of the written report and opposition by the patient to utilise of her medical data. Nosotros chose not to include pregnancy with unknown upshot in lodge to because the % of complications was an important outcome of our study. We wished to be the virtually exhaustive on outcome and avert diagnostic errors.Clinical features, laboratory findings, prescription and outcomes were nerveless from electronic medical records (Diamm©, Villers les Nancy, France / Stare©, France / Carestream©, Rochester, United-Sate) with secure software (Redcap©, Vanderbilt University, Nashville, United Country). Cold Season was defined every bit the menstruation most sensitive for common viral infection, that is from October to March. [[eight]]

2.2. Variables collected: determination of etiology

The management of fever during pregnancy in our gynecological emergency department consists in performing systematically a first line biological piece of work-up including blood tests with hemogram, plasma C-reactive protein (CRP), and bacteriological samples with urine culture (UC), PCR enterovirus in the claret, vaginal swab and hemocultures for Listeria Monocytogene. Second line exam depends on maternal symptoms (ex: PCR influenza if flu-like syndrome, renal ultrasound if lumbar pain, breast x-ray if chest hurting or dyspnea). When fever is not confirmed at presentation, diagnostic testing is decided past the physician. Hospitalization was not systematic in our center,but was largely carried out in case of confirmed fever without certainty of diagnosis, in order to monitor a possible Listeria. Similarly, antibiotic therapy against Listeria monocytogene was largely recommended in the absenteeism of certainty of diagnosis.

2.3. Categorization of etiologies

Etiologies were divided in two different grouping, according the certainty of diagnosis. Diagnosis criteria were decided by CE and OP. All etiologies were than classified past CE. In the rare cases of difficulty in classifying etiologies, cases were reviewed past JS.

• • Certainty of diagnosis
• - Intra uterine infection: fever in the context of premature rupture of membranes, associated with at least one supplementary criteria among the following : persistent fetal tachycardia, painful uterine contractions, spontaneous labor or purulent amniotic fluid defined as the French guidelines [nine].
• - Acute pyelonephritis: lumbar pain and positive urine culture without other most likely diagnosis
• - Influenza: nasopharyngeal PCR positive for influenza A/B
• - Listeriosis: Positive hemoculture for Listeria monocytogene
• - Other: proof of diagnosis explaining the fever, with etiology not classifiable in categories mentioned above
• • Probability of diagnosis (only in the absence of a certain diagnosis)
• - Mutual viral infection: Influenza-like symptoms ie. chills, headache, myalgia, asthenia, coughing without other most probable diagnosis
• - Viral astute gastroenteritis: compatible symptoms (intestinal disorder, nausea/vomiting, abdominal pain) without any other most likely diagnosis
• - Unknown: no etiology plant, eg. no symptoms or piece of work-upwards compatible with any of the diagnoses cited above.

One diagnosis was assigned to every consultation, if 2 diagnoses were possible, the one with the higher probability was selected.

2.four. Statistical assay and upstanding commission

Continuous information were presented equally medians and 25th to 75th percentiles. Categorical information were presented as counts and percentages. For the clarification of outcomes, the 95 % confidence interval was estimated. Fisher exact examination or Chi-square were performed for the categorical data as appropriate. Statistical analysis was performed using R software (version 3.5.ane)

This study was approved by the Institutional Review Lath (IRB status number 00,006,477) number 2018-032.

3. Results

3.1. Diagnoses

Over the study period of one twelvemonth, 3315 patients were followed for their pregnancy, and 121 consulted for fever at dwelling house or at the emergency departments, i.e. 3.half-dozen % (95 % confidence interval [3; four.three]. For 21 of these patients, medical charts were considered as incomplete and were excluded (Fig. 1 ). We compared characteristics of patients according to the confirmation of fever at presentation (N = 45; 45 %; 95 %CI 35–55) vs fever reported only at home (N = 55 ; 55 % 95 %CI 45–65) (Fig. 1).

Flow chart. Women presenting for fever in pregnancy in the emergency department betwixt 08/01/2016 and 07/31/2017.

Median age of patients was 30 years [IQR 26–32]. No patient had preexisting diabetes, immunodeficiency or immunosuppressive therapy and they were all seronegative for HIV, hepatitis C and syphilis. Most consultations took place during cold season (73 % from october to march). Characteristics did not differ between the two groups (Table ane ) except for the flow of consultation (winter was more frequent in the group with no confirmed fever, p < 0.005).

Table 1

Feature of the 100 included significant women according the fever condition at presentation (confirmed vs merely at dwelling house).

		All patients (n = 100)		Fever at presentation (n = 45)			Fever just at dwelling house (n = 55)			P Value*
		N	%		N	%		Northward	%
Demographics	Age									0.i
	- 18-25	17	17		11	24		6	11
	- 25-35	66	66		25	56		41	74
	- > 35	17	17		9	xx		eight	15
	Parity									0.86
	- 0	fifty	50		21	47		29	53
	- 1	27	27		xiii	29		14	25
	- 2 or more	23	23		11	24		12	22
Pregnancy	Type of gestation
	- Singleton	95	95		42	93		53	96	0.65
	- Twins	5	five		three	7		2	iv
	Immunized for rubella	93	93		41	91		52	95	0.69
	Immunized for toxoplasmosis	43	43		22	49		20	36	0.22
	Hepatitis B
	- non immunized	78	78		34	76		44	lxxx	0.63
	- vaccinated	20	20		10	22		10	28	0.62
	- cured	ii	ii		ane	2		1	2	i
	- chronic	0	0		0	0		0	0	1
	Diabetes	19	xix		9	twenty		10	18	1
Consultation	Gestational age
	- 0−13 WG	12	12		four	9		8	fourteen	0.53
	- xiv−24 WG	36	36		19	42		eighteen	33	0.4
	- 25−31 W G	nineteen	19		8	18		xi	20	0.8
	- >32 WG	32	32		fourteen	31		18	33	1
	Month of consultation
	- October-March	73	73		24	53		49	89	<0.005
	- April-September	27	27		21	47		half-dozen	11	<0.005
	Antibiotic therapy before consultation	5	5		2	four		3	5	ane

Concerning the etiologies of fever, 42 patients (42 % ; 95 %CI 32–52) had a certain diagnosis: 21 influenza (21 % ; 95 %CI 13–29), xi acute pyelonephritis (11 % ; 95 %CI 5–17), 5 intra uterine infection (5% ; 95 %CI 1–9), 5 others (five% ; 95 %CI 1–10) (detailed in Table 2 ), and 58 patients (58 % ; 95 %CI 48–67) had only a uncertain diagnosis : 37 common viral infection (37 % ; 95 %CI 28–46), including 2 cases of rhinovirus diagnosed on multiplex PCR, 6 viral astute gastroenteritis (6% ; 95 %CI 1–11) and fifteen unknown (15 % ; 95 %CI 8–22). (Table 2). Certain diagnosis was more often reported in women with confirmed fever at presentation than among women who reported fever only at dwelling house (60 % vs 27 %, p = 0.001). No instance of listeria was diagnosed. Common viral infection are defined as association of fever with i or more than flu-similar symptoms (chills, headache, myalgia, asthenia, coughing), whereas in example of no symptoms associated to fever, we classified as unknown diagnosis (N = 15).

Tabular array ii

Etiologies of the 100 included pregnant women according to the fever status at presentation (confirmed vs only at dwelling).

		All patients (due north = 100)	Fever at presentation (n = 45)	Fever merely at home n = 55)
Certain diagnosis	Influenza	21 (21 %)	10 (22 %)	11 (20 %)
	Acute pyelonephritis	11 (11 %)	eight (18 %)	3 (six%)
	Intra uterine infection	5 (5%)	5 (eleven %)	0 (0%)
	Other	5 (5%)	iv (9%)i	i (two%)2
Uncertain diagnosis	Common viral infection	37 (37 %)	11 (25 %)	26 (47 %)
	Viral acute gastroenteritis	6 (6%)	0 (0%)	6 (10 %)
	Unknown diagnosis	15 (fifteen %)	7 (xv %)	8 (15 %)

Intrauterine infections occurred in patients who all had premature rupture of membranes: three at term and one at 22 W Grand in a context of known cervical incompetency. The terminal ane occurred in a case of prolonged rupture of membranes: PPROM was diagnosed at 17 West G and intra uterine infection at 31 Westward G.All patients were in labor except two, at term, for which induce of labor was necessary.

3.two. Hospitalization and complications

In the group with confirmed fever at presentation, 46 % (21 of 45 patients; 95 %CI 32–62) were hospitalized, for a median of 3 days [IQR 2–4] and 22 % (ten of 45 patients; 95 %CI 10–34) presented maternal or fetal complications (Table three ). The fetal complications were: ii (4%) early miscarriage, two (4%) late miscarriage, 2 (iv%) preterm delivery at 31 West G and 26 W G, 1 (2%) stillbirth. The maternal complications were: 1 (2%) hospitalization for painful uterine contractions without preterm labor, 3 (half dozen%) severe sepsis, 1 additional patient (ii%) who required hospitalization in intensive intendance unit.

Table 3

Complications and hospitalization of the 100 included meaning women co-ordinate to fever status at presentation (confirmed vs but at home).

		All patients (northward = 100)	Fever at presentation (n = 45)	Fever merely at dwelling (n = 55)	P Value*
Hospitalization	Rate	25 (25 %)	21 (46 %)	four (7%)	< 0.001
	Median duration [IQR]	3 [2–4]	3 [two–four]	2,five [1.75−3]
Fetal complications	Prematuritythree	two	2	0	0.two
	Late miscarriage2	2	two	0	0.2
	IUFD	2	ane	1	ane
	Early miscarriage2	4	2	2	1
	Total	x (ten %)	7 (15 %)	iii (5%)	0.1
Maternal complications	Intensive care	ane	1	0	0.45
	Severe sepsis	3	3	0	0.08
	Threatened preterm birth	1	1	0	0.45
	Total	v (five%)	v (11 %)	0 (0%)	0.01
Total complications		13 (13 %)1	10 (22 %)1	3 (5%)i	0.01

Early miscarriage occurred at 11 and 6 W K, i with a mutual viral infection and the other with positive flu PCR. Late miscarriage concerned 2 patients. The first occurred at nineteen Due west Grand, post-obit hospitalization for fever, contraction and bleeding related to a subchorionic hematoma. The other was the intra uterine infection at 22 W G cited above.

1 preterm delivery was the intra uterine infection at 31 West G with PPROM cited above. The other preterm commitment occurred in a patient hospitalized at 26 W G for bleeding and uterine contraction with a temperature of 38 °C (100.4 °F) without evidence for intra uterine infection. The patient underwent a caesarean department for not-reassuring fetal middle rate and spontaneous labor, 2 days after hospitalization. Bacteriologic sample subsequently nascence was negative.

The stillbirth occurred after voluntary intoxication with 10 intra vaginal misoprostol tablets at 21 W G. The patient presented a severe instance of hyperthermia at 40.7 °C (105.3 °F). No other etiology for fever was found.

One patient required intensive care unit hospitalization because of herpetic meningitis. She consulted at 38 W One thousand with fever (38.6 °C/101.five °F), chills, emesis, headache, and signs of confusion. PCR HSV in the cerebrospinal fluid was positive. A caesarean section was decided at 38 West 1000 following clinical deterioration with hemodynamic instability. The patient delivered a 3200 g male person infant, PCR HSV on the newborn was negative and he had a normal evolution. Maternal hospitalization was complicated by pneumonia and she was able to leave the intensive care unit later fourteen days.

Both hospitalizations and complications were less frequent in the group with no confirmed fever at presentation (Fisher'south exact test p < 0.001 and p = 0.01 respectively). Among them, 3 of 55 (5% ; 95 %CI 0–xi) had complications : miscarriage at vii and 8 Due west G and a fetal demise at 15 W G with no other cause. The patient consulted for fever at 38° at home, not confirmed at presentation, associated with headache and chest pain. Consecration of labor was performed, and she delivered without complications or fever; the fetus had no apparent malformation. Among patients with no fever confirmed, 4 out of 55 (vii%; 95 %CI 0.2–14) were hospitalized, for a median of 2,5 days [IQR ane.75−3].

We too compared the charge per unit of hospitalization and complications according to the fact that diagnosis was certain or not. Hospitalization rate was lower among patients for which the diagnosis was uncertain, 7/58 (12 %; 95 %CI 4–20) than amid patients for which diagnosis was certain : eighteen/42 hospitalizations, 43 %, p < 0.001). Rate of complexity did not differ : 8/58 (fourteen % (95 %CI 5–22) for uncertain diagnosis vs 5/42 complications, 12 %, for patients with certainty of diagnosis p = ane.0).

3.3. Biological results

Amid all patients, 43 % (43/100) had claret exams with C-reactive protein (CRP), 29/45 of women with fever in the ER and 14/55 of women with fever only at domicile. CRP levels was not significantly different in the group with complications than in the group without complications. (29.vii mg/L vs 45.8 mg/50, p = 0.221). (Fig. 2 ). Moreover, 25 % patients (2/viii) in the group with complications had negative CRP (<6 mg/L) and 9% patients (3/35) had negative CRP in the group without complications. The negative predictive value of a positive CRP for an adverse event was sixty %.

Comparative level of C-reactive protein (CRP) in mg/50 and white count cells at the time of consultation for fever in the grouping with complications of pregnancy and the group without complications.

Amidst all patients, 58 % (58/100) had blood exams with white count cell (WCC), 37/45 of women with fever in the ER and 21/55 of women with fever only at home. WCC levels in the group with complications was significantly higher than in the group without complications. (14,070 × x⁹/Fifty vs 10,720 × 10^nine/L [IQR 8100; xiii,063] p = 0.03) (Fig. 2).

3.4. Antibiotics prescription and maternal treatment

Among all included women, 45 % (45/100) received antibiotics and 29 % (29/100) received antibiotics targeting listeria (amoxicillin two 1000 10 3 per days until issue of blood cultures). Intra uterine infection and acute pyelonephritis were treated with appropriate antibiotics. Amid 21 patients with influenza (PCR test positive), 15 received oseltamivir (75 mg x two per day for five days) and the other half dozen patients did not receive oseltamivir, because symptoms occurred more than 48 h before the consultation. Three additional patients received oseltamivir although the PCR test was negative. Among the 32 patients with confirmed fever at presentation and no acute pyelonephritis or intrauterine infection, probabilistic antibiotic confronting Listeria monocytogene was prescribed for 19 patients (59 %, 19/32). No instance of listeria was diagnosed. Prescription of antibiotics was more frequent among women with confirmed fever at presentation than among women who reported fever only at abode (75 % vs 20 %, p < 0.001).

4. Discussion

Although fever in pregnancy is a mutual clinical result, this is the first written report to approximate the prevalence of different etiologies and to describe management and complications. The diagnosis remained uncertain in the majority of cases later on the initial work-upwards (58 %). When fever was confirmed at presentation, 22 % of adult a maternal or fetal complication. When the diagnosis was uncertain at the terminate of the test, the majority (59 %) received antibody therapy targeting Listeria monocytogenes. Uncertain diagnosis was non associated with length of hospital stay or a higher rate of complications. The big proportion of complications can probably be explained by the fact that patients consulting at the hospital emergency department are probably the about severe cases. Although advice is given to patients to come to the emergency section in instance of temperature > 38 °C, it is likely that some of the least severe patients may have consulted their main physicians first, and our study may thus exist biased towards the near severe patients. Incidence of fever during pregnancy (i.e. 3.vi %) is probable underestimated, because some patients may accept consulted elsewhere, or non.

Influenza was one of the nigh frequent etiologies in our series. The flu test was more often than not performed using specific PCR, only in five cases, multiplex PCR was performed, detecting ii positive cases for rhinoviruses. Two retrospective studies conducted during the 2009–2010 flu pandemic constitute in pregnant women with influenza-like symptoms, non-influenza respiratory viruses rates of 23 %, and flu H1N1 rates betwixt 31 and 42 %, like to our results [10,11]. The multiplex PCR was not used on a routine basis because it is expensive and time-consuming, although this strategy could perhaps avoid use of antibiotics and hospitalizations. Some studies take evaluated clinical and economic impact of multiplex respiratory virus assays, with different results, but this has never been assessed in a pregnant population [12]. Some other alternative to the standard real-time flu PCR for wich results is oft delivered after several hours is to use a rapid molecular analysis. A recent written report highlight benefit on hospitalization and antibiotics consumption, but no economic impact was washed [13]. Some other novel biological tests, such as RNA biosignature are promising, but need to be validated [14]. In this study, CRP seems not to be predictor for adverse outcome, different white count cell. However, the depression number of patients and the retrospective design of our study requires careful estimation of this results. Although in that location is a protocol for the direction of fever in our emergency department, this ane was non always respected. For example, CRP and hemogram was performed in merely 58 % of the consultations and enterovirus PCR was never prescribed, although we now recommend performing it systematically in view of the fetal and neonatal risks reported recently (15).

The current COVID-xix pandemic demonstrates performing a rapid diagnosis in pregnant women presenting with fever allow for advisable care, including hospitalization vs. outpatient direction and whether or non to prescribe antibiotics.

Our study demonstrates that fever during pregnancy is associated with a high rate of adverse events. The master strength of this written report is the inclusion of all patients consulting for fever, and therefore including those where diagnosis was not certain. There is no respond available for patients who reported fever simply at habitation, even though clinicians are regularly face to this situation. The assay of this population in our studies is an original approach. These patients are mostly excluded from other studies, although etiology or inflammation associated with fever may have consequences for them as well [xvi,17]. In this subgroup, nosotros found a significant rate of complications (xiv %), ane half of the total complications, fifty-fifty if complications are probably virtually frequently the effect of the etiology or inflammation, and not fever per se. Because of this upshot, non shown until now, information technology seems necessary to conduct farther prospective studies evaluating the rate of complication in case of fever, fifty-fifty if in cases where diagnosis is unclear. The complication rate was lower when fever was not confirmed, possibly related to less severe infections and in an unknown proportion an overestimation of the temperature when taken at home. Management of pregnant women with fever at home but not confirmed at presentation has not been described previously.

Management of fever during pregnancy, particularly the rate of antibiotic prescription, has never been evaluated, different in other populations (emergency section for adult or pediatric population), although assistants of an antibiotic is much college in pregnant women than in these populations. Beyond the allergic risk, price-efficacy, and the issue of antibiotic resistance, recent data suggests that antibiotic therapy during pregnancy could influence the microbiota of newborn and influence adventure of diabetes and obesity [7,[18], [xix], [20]]. Most patients (58 %) have an uncertain diagnosis at the end of the consultation, and listeriosis is considered, given the high risk of complications including fetal loss. This may lead to excessive prescription of antibiotics despite the rarity of the diagnosis (almost 30 cases per year in French republic among 800 000 births). In the study conducted by Charlier et al. out of 107 cases of fetal infection with Listeria monocytogenes, only v% of patients had an isolated fever. [21] We believe that developing more reliable diagnostic and prognostic strategies would reduce unnecessary hospitalizations, and unnecessary antibiotic prescriptions and thus economic costs, while existence more than vigilant when there is a significant risk of complications.

The limitations of this study are the size of our population and its retrospective observational nature. There are no confirmed criteria to predict a complication when a pregnant woman presents with fever, except co-ordinate to specific diagnoses such as intrauterine infection. The low size of our population does not let us to make this type of prediction. As our series was retrospective, some data may exist lacking. All women with a temperature of 38 °C or more than at presentation were identified. Nevertheless, fever earlier presentation may be under-reported. Besides, while all drug prescriptions were recorded, actual antibiotic consumption, particularly concerning duration of the treatment, may have been variable depending on patients' compliance. Classifications of etiologies was done by several observers, but in some cases symptoms was unusual and non systematically confirm with microbiological or histologic investigations. As example, simply the tardily miscarriage had placental assay, which confirm histologic intra uterine infection. Unfortunately, for other patients, placental analysis was not available.

v. Conclusion

Fever during pregnancy was associated with a high rate of complications, 22 % overall. Farther, prospective studies on larger cohorts, should be conducted to clarify the medical and public health consequences, including in the longer term, identify prognostic factors and allow for the written report of new strategies.

References

ane. Charlier C., Perrodeau E., Levallois C., Cachina T., Dommergues Grand., Salomon L.J. Causes of fever in pregnant women with acute undifferentiated fever: a prospective multicentric study. Eur J Clin Microbiol Infect Dis. 2020;(January):xviii. [PubMed] [Google Scholar]

2. Surgers Fifty., Valin N., Carbonne B., Bingen E., Lalande V., Pacanowski J. Evolving microbiological epidemiology and high fetal mortality in 135 cases of bacteremia during pregnancy and postpartum. Eur J Clin Microbiol Infect Dis. 2013;32(1):107–113. [PubMed] [Google Scholar]

3. Knowles S.J., O'sullivan N.P., Meenan A.G., Hanniffy R., Robson One thousand. Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study. Bjog Int J Obstet Gynaecol. 2015;122(v):663–671. [PubMed] [Google Scholar]

4. Mertz D., CK-F Lo, Lytvyn L., Ortiz J.R., Loeb M. Pregnancy as a take a chance factor for severe influenza infection: an individual participant data meta-assay. BMC Infect Dis. 2019;19(i):683. [PMC free article] [PubMed] [Google Scholar]

5. Wing D.A., Fassett M.J., Getahun D. Acute pyelonephritis in pregnancy: an 18-year retrospective assay. Am J Obstet Gynecol. 2014;210(March (three)):219. e1-6. [PubMed] [Google Scholar]

6. Towers C.V., Yates A., Zite North., Smith C., Chernicky L., Howard B. Incidence of fever in labor and hazard of neonatal sepsis. Am J Obstet Gynecol. 2017;216(6):596. e1-596.e5. [PubMed] [Google Scholar]

7. Laxminarayan R., Matsoso P., Pant S., Brower C., Røttingen J.-A., Klugman K. Admission to effective antimicrobials: a worldwide challenge. Lancet. 2016;387(January (10014)):168–175. [PubMed] [Google Scholar]

8. Broberg E.K., Waris Grand., Johansen Yard., Snacken R., Penttinen P., European Influenza Surveillance Network Seasonality and geographical spread of respiratory syncytial virus epidemics in 15 European countries, 2010 to 2016. Euro Surveill. 2018;23(5) [PMC free article] [PubMed] [Google Scholar]

ix. Beucher Grand., Charlier C., Cazanave C. Diagnosis and management of intra-uterine infection: CNGOF preterm premature rupture of membranes guidelines. Gynecol Obstet Fertil Senol. 2018;46(12):1054–1067. [PubMed] [Google Scholar]

x. Pilorgé 50., Chartier K., Méritet J.-F., Cervantes Grand., Tsatsaris Five., Launay O. Rhinoviruses as an underestimated cause of influenza-like illness in pregnancy during the 2009-2010 influenza pandemic. J Med Virol. 2013;85(August (viii)):1473–1477. [PubMed] [Google Scholar]

11. Paño-Pardo J.R., Martínez-Sánchez Due north., Martín-Quirós A., Romero-Gómez K.P., Muñoz-Muñiz M., Sánchez-Pastor M. Influenza-like disease in pregnant women during summer: clinical, epidemiological and microbiological features. Eur J Clin Microbiol Infect Dis. 2011;xxx(December (12)):1497–1502. [PMC costless article] [PubMed] [Google Scholar]

12. Vallières E., Renaud C. Clinical and economical impact of multiplex respiratory virus assays. Diagn Microbiol Infect Dis. 2013;76(July (three)):255–261. [PMC free article] [PubMed] [Google Scholar]

13. Anselem O., Baraud C., L'Honneur A.-S., Gobeaux C., Rozenberg F., Goffinet F. Improving care for pregnant women with suspected influenza: a retrospective report earlier and after introduction of a rapid molecular assay. PLoS One. 2019;14(June (six)) [PMC free article] [PubMed] [Google Scholar]

14. Mahajan P., Kuppermann N., Mejias A., Suarez N., Chaussabel D., Casper T.C. Clan of RNA biosignatures with bacterial infections in delirious infants aged 60 days or younger. JAMA. 2016;316(August (eight)):846–857. [PMC costless commodity] [PubMed] [Google Scholar]

fifteen. Méreaux J., Picone O., Vauloup-Fellous C., Khediri Z., Benachi A., Mandelbrot 50. [Enterovirus infection during pregnancy: underestimated cause of fetal and neonatal complications?] Gynecol Obstet Fertil Senol. 2017;45(April (iv)):231–237. [PubMed] [Google Scholar]

16. Kalagiri R.R., Carder T., Choudhury S., Vora Due north., Ballard A.R., Govande V. Inflammation in complicated pregnancy and its outcome. Am J Perinatol. 2016;33(xiv):1337–1356. [PubMed] [Google Scholar]

17. Ashwal E., Salman 50., Tzur Y., Aviram A., Ben-Mayor Bashi T., Yogev Y. Intrapartum fever and the risk for perinatal complications - the issue of fever elapsing and positive cultures. J Matern Fetal Neonatal Med. 2018;31(June (11)):1418–1425. [PubMed] [Google Scholar]

eighteen. Stoll B.J., Hansen N., Fanaroff A.A., Wright L.L., Carlo W.A., Ehrenkranz R.A. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med. 2002;347(July (4)):240–247. [PubMed] [Google Scholar]

19. Jauréguy F., Carton Thou., Panel P., Foucaud P., Butel Grand.-J., Doucet-Populaire F. Furnishings of intrapartum penicillin prophylaxis on intestinal bacterial colonization in infants. J Clin Microbiol. 2004;42(Nov (11)):5184–5188. [PMC free article] [PubMed] [Google Scholar]

20. Kuperman A.A., Koren O. Antibody use during pregnancy: how bad is it? BMC Med. 2016;xiv(one):91. 17. [PMC free commodity] [PubMed] [Google Scholar]

21. Charlier C., Perrodeau É, Leclercq A., Cazenave B., Pilmis B., Henry B. Clinical features and prognostic factors of listeriosis: the MONALISA national prospective accomplice study. Lancet Infect Dis. 2017;17(5):510–519. [PubMed] [Google Scholar]

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7444605/

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