Internal monitors associated with fever in laboring mothers

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1. Use of intrauterine pressure catheters (IUPC) was associated with increased risk of maternal fever. 

2. When used alone, fetal scalp electrodes (FSE) were associated with decreased risk of cesarean delivery. 

Study Rundown: This study suggests that the routine use of internal monitors in laboring patients may be associated with increased odds for maternal fever and cesarean delivery. Findings also highlight differences in outcomes by monitor type: while the use of IUPC alone was associated with increased odds for maternal fever, the use of FSE alone was associated with decreased odds for cesarean delivery. Limitations of this investigation include the inability to assess potential confounders, such as the number of attempts to place internal monitors and the timing of monitor placement with regard to the development of maternal or fetal distress. Generalizability may also be limited, as the study population was predominantly African American and had a high incidence of obesity. Ideally, this research question would be investigated in a randomized trial, which would be unethical in laboring women; instead, future studies might assess whether these trends hold across a more diverse population.

Study Author, Dr. Lorie Harper, MD talks to 2 Minute Medicine: University of Alabama at Birmingham

“The key findings of this study are that although fetal scalp electrode (FSE) use was associated with a decreased risk for cesarean delivery, the use of an intrauterine pressure catheter (IUPC) was associated with an increase in the risk of maternal fever without an associated decrease in the risk of cesarean delivery.  Although these monitors are placed routinely (in 60% of laboring women in our study), clinicians should remember that even the most routine procedure may be associated with risk, and internal monitors should be placed as needed for patient management rather than as a matter of routine.”

Click to read the study in the American Journal of Obstetrics and Gynecology 

In Depth [retrospective cohort study] evaluated the association of internal monitors with the incidence of adverse maternal and fetal outcomes in women with a singleton pregnancy who labored at a single tertiary care center between 2004 and 2008. 3,944 women with internal monitors (625 with FSE only; 789 with IUPC only; 2,530 with both) and 2,501 without monitors were included in analysis. Outcomes included maternal fever (temperature ≥38.1°C), cesarean delivery and a composite neonatal outcome (5-minute Apgar score, cord blood pH, cord blood base excess, admission to a level 3 nursery).

Women with internal monitors were more likely to develop fever during hospitalization compared to participants without internal monitors (OR: 2.0, CI 1.6-2.5). Use of IUPC alone was associated with increased incidence of fever (OR:2.4, CI 1.8-3.2), while use of FSE alone was associated with a decreased incidence of cesarean delivery (OR:0.5, CI 0.4-0.7). The combined use of IUPC and FSE was associated with increased odds of both maternal fever (OR:2.0, CI 1.3-3.0) and cesarean delivery (OR:1.6, CI 1.4-2.0).

By Denise Pong and Leah Hawkins

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