- 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.
- 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.
- 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.
- Retrospective study.
- Not all placentas examined.