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Maternal intrapartum pyrexia audit
  1. SV Darbhamulla,
  2. M Nakade,
  3. P Pradhan
  1. Heartlands Hospital, Birmingham, UK

Abstract

Aim To evaluate adherence to departmental guidelines in management of women with intrapartum fever.

Methodology Retrospective audit performed from January to June 2009. Inclusion criteria was maternal fever over 38° during labour. 42 cases were selected, 36 notes reviewed.

According to guideline women with fever over 38°, should have blood cultures along with infectious screen (mid stream specimen of urine for culture and sensitivity, high vaginal swab, full blood count) and to receive intravenous antibiotics for 48 h (Benzyl penicillin, gentamycin, metronidazole).

Results Out of 36 women, 21 laboured spontaneously, labour was induced in 15. 17 women had SROM (spontaneous rupture of membranes), duration varied from 4 to 140 h. 18 women had ARM (artificial rupture of membranes); ARM to delivery interval was 40 min to 25 h.

Blood cultures were performed in 28 (77%), and were GBS (Group B streptococcus) positive in two. 16 MSU sent, one GBS positive. Two out of 12 LVS (low vaginal swab) were GBS positive. Antibiotics were given in 23 (63%).

17 (47%) delivered by Emergency LSCS, 15 (41%) vaginal delivery and four had instrument delivery.

28 (77%) women were delivered with in 4 h from temperature spike.

In 55% temperature settled with in 4 h. 69% Women were discharged home in 3–4 days. 14 (40%) babies were admitted to neonatal unit. Positive for GBS in two, Escherichia coli in one.

Conclusion Blood cultures were performed in (77%). 63% received antibiotics as per protocol. The authors felt early delivery has contributed to good out come for mothers. There is high morbidity in neonatates 40% admitted to neonatal unit. Audit suggested reducing the duration of intravenous antibiotics to 24 h and to change antibiotic policy.

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