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

Gianna L. Wilkie; Kaitlyn James; Samsiya Ona; Sarah Rae Easter; Joseph Chou; Drucilla Roberts; Zehra Ordulu Sahin; Ruth Tuomala; Khady Diouf; Laura Riley; Malavika Prabhu

doi:10.1055/s-0041-1727279

American Journal of Perinatology, Inhaltsverzeichnis

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

¹Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

²Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

³Department of Obstetrics and Gynecology, University of Massachusetts Medical School, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts

,

Kaitlyn James

²Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

,

Samsiya Ona

¹Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

²Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

,

Sarah Rae Easter

¹Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

,

Joseph Chou

⁴Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

,

Drucilla Roberts

⁵Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

,

Zehra Ordulu Sahin

⁵Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

,

Ruth Tuomala

¹Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

,

Khady Diouf

¹Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

,

Laura Riley

²Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

⁶Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York City, New York

,

Malavika Prabhu

²Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

⁶Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York City, New York

› Institutsangaben

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

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Referenzen

References
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