Fever during termination of pregnancy is an unreliable symptom of intrauterine infection

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Takeaway

  • Fever during second trimester termination of pregnancy associated with misoprostol and not intrauterine infection.

Why this matters

  • Fever has a low positive predictive value (PPV) for intrauterine infection in the setting of second trimester termination of pregnancy.
  • Fever is a adverse effect of misoprostol and not a sign of chorioamnionitis in these patients.
  • The use of antibiotics without other signs of infection is questionable.

Key results

  • 42% of participants developed fever.
  • Most developed fever within 10 h of start of procedure and disappeared after expulsion.
  • Women who developed fever were more likely to have a later gestation, be nulliparous, have a longer induction-expulsion time, and have used higher doses of misoprostol.
  • In patients with fever, 3% had evidence of infection by placental pathology.
  • In patients without fever, 2% had evidence of infection by placental pathology.
  • Fever is unreliable indicator, has PPV of 4% for infection.

Study design

  • Retrospective descriptive study.
  • Second trimester pregnancy terminations between 2008 and 2012 using mifepristone and misoprostol were included (n=403).
  • Patients with and without fever were compared.
  • Placental pathology, C-reactive protein, white blood cell counts, blood, vaginal, and urine cultures, and use of antibiotics analyzed.
  • Funding: None.

Limitations

  • Retrospective study.
  • Not all placentas examined.