Evaluation of the Risk of Infection During Fever in Labor

Evaluation of the Risk of Infection During Fever in Labor

• Fever during labor affects more than 8% of parturients. It is a heterogeneous entity and can be due to an infectious process, a side effect of a drug, or to labor itself (physiological hyperthermia).
• It has been the subject of several retrospective studies and a few prospective studies with varying methodologies, definitions, and inclusion criteria. None have proposed a combined obstetric, neonatal, infectious disease, and microbiological analysis.
• It raises concerns about the possibility of an emerging maternal (obstetric or otherwise) and/or fetal infection.
• Analysis of the available literature does not clarify the exact frequency of these infections or the predictive factors for their occurrence.
• It often justifies systemic antibiotic therapy, the modalities and benefits of which have never been evaluated.

The investigators aim to conduct a prospective multicenter study to analyze fever during labor with a combined obstetric, infectious disease, pediatric, and microbiological perspective.

The primary objective of this study is to analyze the causes of fever during labor by categorizing them into 3 etiological categories:

1. Fever indicative of maternofetal infection: potentially early intrauterine infection leading to proven or probable early-onset neonatal bacterial infection, endometritis, or maternal sepsis.
2. Fever indicative of maternal infectious pathology outside the obstetrical field (e.g., pyelonephritis, influenza, COVID, etc.).
3. Fever of non-infectious origin.

Secondary objectives include:

• Describing the epidemiology and local ecology of bacterial infections.
• Identifying predictive factors for each category (obstetrical infection, non-obstetrical infection, and non-infectious fever) when fever occurs during labor.
• Evaluating the maternal and neonatal prognosis of mother-child pairs who do not receive antibiotic treatment according to local protocols (e.g., in cases of fever below a threshold value).

Depending on the results and sample size, the study will also attempt to evaluate the maternal and neonatal prognosis of mother-child pairs in cases where fever is attributed to maternofetal infectious causes (category 1) according to the antibiotic management strategy for fever during labor at each center.

Inclusion Criteria:

• Pregnant women at least more than 37 weeks
• Who have not opposed the collection of their health data for the purposes of studies and analyzes
• In work between 07/01/2023 and 06/01/2024
• Admitted to the work room at Port Royal, Necker Sick Children or Trousseau
• With fever defined as a tympanic temperature > 38°C at least 2 times at 10 min intervals during labor.

Exclusion Criteria:

• Pregnant women :
• < 37NT
• express their opposition to the collection of their data for research purposes
• minors or under legal protection
• context of medical termination of pregnancy or fetal death