The American College of Obstetrics and Gynecology currently recommends that antibiotic treatment be considered for women with isolated maternal fevers in labor. However, there is little known about the maternal and neonatal impact of antibiotic treatment in this scenario.
We sought to assess outcomes in women with a non-sustained, isolated maternal fever, treated with antibiotics versus expectant management.
This is a retrospective cohort study of laboring women with a singleton gestation at term and a single temperature between 38.0° and 38.9° C, without other evidence of infection (leukocytosis > 15,000/mm, fetal tachycardia, malodorous amniotic fluid, suspected alternate source of infection) at a tertiary teaching hospital. A contemporaneously maintained, validated obstetric database was used to identify women. Women with rheumatologic or renal disease, non-gestational diabetes, preterm labor, abruption, vaginal bleeding, human immunodeficiency virus, malpresentation, and fetal anomalies were excluded. The primary outcome was postpartum fever above 38.0° C. Secondary maternal outcomes were treatment for postpartum endometritis, uterine atony, postpartum hemorrhage, admission to the intensive care unit, and postpartum length of stay. Secondary neonatal outcomes were Neonatal Intensive Care Unit admission, 5 minute Apgar <7, 5 minute Apgar <4, Neonatal Intensive Care Unit length of stay, and neonatal antibiotic administration. Results were compared using univariable and multivariable analyses.
From January 1, 2015 to December 31, 2018, 359 women were identified; 85 received antibiotics (ABX) and 274 did not (NO-ABX). Baseline characteristics were similar between groups, aside from gestational age at time of delivery (39.2 ABX vs. 39.5 weeks NO-ABX, p = .02). Postpartum fever trended lower in the antibiotic group (10.59% ABX vs. 18.98% NO-ABX, p = 0.07). Significantly fewer women in the antibiotic group were treated for postpartum endometritis (3.53% ABX vs. 11.31% NO-ABX, p = 0.03). Neonatal Intensive Care Unit admission and neonatal antibiotic administration rates were higher in the antibiotic group (41.18% ABX vs. 17.88% NO-ABX, p = <0.001 and 36.47% vs. 12.41%, p = < 0.001). Five minute Apgar <7 was more common in the antibiotic group (8.25% vs. 2.19%, p = 0.016). After controlling for age, gestational age, BMI, GBS status, delivery method, parity, presence of epidural, and receipt of acetaminophen, the odds of postpartum fever were reduced by a factor of 0.42 (95% CI: 0.18-0.99) among those women who received antibiotics in comparison with those who did not.
While there was a lower rate of treatment for endometritis in women who received antibiotics for a single isolated maternal fever, there was a higher rate of Neonatal Intensive Care Unit admission and five minute Apgar<7. This indicates likely maternal benefit of antibiotic use, however, raises concern for neonatal risk.

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