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12. Fever in Pregnancy
12.1 Introduction and Definitions
Fever in pregnancy refers to elevated temperature above the normal variation, often associated with other symptoms.
RCOG defines maternal pyrexia as temperature of 38.0 °C once or 37.5 °C on two occasions 2 h apart [1].
Pyrexia is both a symptom and sign which should be taken seriously as it can have dire maternal and fetal consequences. Maternal fever in pregnancy or labor is primarily a cause for concern as we need to deal with two patients, mother and fetus [2]. The duration of fever, the time of occurrence during gestation, and the maximum temperature reached determine the fetal effects irrespective of the cause of fever.
Sepsis may be defined as infection plus systemic manifestations of infection.
Septic shock is defined as the persistence of hypoperfusion despite adequate fluid replacement therapy [3].
12.2 Causes of Fever
Type of infection | Causes |
|---|---|
Systemic infection | |
Viral | Influenza, rubella, CMV, herpes |
Bacterial | GAS, E. coli, Streptococcus, Staphylococcus, toxic shock syndrome, Pseudomonas species |
Protozoal | Malaria, toxoplasmosis, amoebiasis |
Organ-specific infection | |
UTI | Cystitis, pyelonephritis |
Respiratory | Pneumonia, bronchitis, TB, influenza |
Uterine | Chorioamnionitis, STDs |
Gastrointestinal | Hepatitis, pancreatitis, enteritis, appendicitis |
Cardiac | Subacute bacterial endocarditis |
Neurological | Meningitis, malaria, amoebiasis |
Noninfectious causes | |
Connective tissue disorders | Rheumatoid arthritis |
Autoimmune disorders | SLE, inflammatory bowel disease |
Drugs | Procainamide, alpha-methyldopa, isoniazid |
Sickle cell crisis | Bone crisis, acute chest syndrome, abdominal crisis, joint crisis |
Endocrine/metabolic causes | Diabetic ketoacidosis, pheochromocytoma Hyperthyroidism |
Thrombosis | DVT, pulmonary embolism |
Malignancy | Leukemia, lymphoma |
Pyrexia of unknown origin | |
Postpartum causes | |
Genital tract infection | Endometritis, pelvic abscess |
UTI | Cystitis, pyelonephritis |
Breast | Engorgement, acute mastitis, breast abscess |
Wound infection | Caesarean section, episiotomy, perineal tear |
Any acute or chronic infectious disease may be contracted during pregnancy, and conception may occur in women already suffering from infection.
12.3 Clinical Features
Skin rash.
Difficulty in breathing or shortness of breath.
Persistent cough.
Persistent diarrhea or vomiting.
Jaundice.
Bruising or unusual bleeding.
Decreased consciousness.
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