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Am J Perinatol 2023; 40(03): 250-254
DOI: 10.1055/s-0041-1727279
Clinical Opinion

Innovating Evaluation and Treatment of Intrapartum Fevers: Where Do We Go from Here?

Gianna L. Wilkie
1   Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
2   Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
3   Department of Obstetrics and Gynecology, University of Massachusetts Medical School, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts
,
Kaitlyn James
2   Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Samsiya Ona
1   Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
2   Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Sarah Rae Easter
1   Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Joseph Chou
4   Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Drucilla Roberts
5   Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Zehra Ordulu Sahin
5   Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Ruth Tuomala
1   Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Khady Diouf
1   Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Laura Riley
2   Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
6   Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York City, New York
,
Malavika Prabhu
2   Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
6   Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York City, New York
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Abstract

As intrapartum fevers are not always infectious in origin, determining whether antibiotics are indicated is challenging. We previously sought to create a point-of-care calculator using clinical data available at the time of an intrapartum fever to identify the subset of women who require antibiotic treatment to avoid maternal and neonatal morbidity. Despite the use of a comprehensive dataset from our institutions, we were unable to propose a valid and highly predictive model. In this commentary, we discuss why our model failed, as well as future research directions to identify and treat true intraamniotic infection. Developing a risk-stratification model is paramount to minimizing maternal and neonatal exposure to unnecessary antibiotics while allowing for early identification of women and babies at risk for infectious morbidity.

Key Points

  • Determining whether antibiotics are indicated in intrapartum fever is challenging.

  • Developing a risk-stratification model for febrile laboring women is critical to decreasing harm.

  • A point-of-care calculator based on clinical and biomarker data is the necessary approach.

Keywords

intrapartum fever - early onset sepsis - intraamniotic infection


Publication History

Received: 17 July 2020

Accepted: 02 March 2021

Article published online:
20 April 2021

© 2021. Thieme. All rights reserved.

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