Outcomes associated with Antibiotic Administration for Isola
The American College of Obstetrics and Gynecology currently recommends that antibiotic treatment be considered for women with isolated maternal fevers in labor.

Researchers sought to assess outcomes in women with a non-sustained, isolated maternal fever, treated with antibiotics versus expectant management.

This is a retrospective cohort study of laboring women with a singleton gestation at term and a single temperature between 38.0° and 38.9° C, without other evidence of infection at a tertiary teaching hospital. A contemporaneously maintained validated obstetric database was used to identify women.

The primary outcome was postpartum fever above 38.0° C. Secondary maternal outcomes were treatment for postpartum endometritis, uterine atony, postpartum hemorrhage, admission to the intensive care unit, and postpartum length of stay. Secondary neonatal outcomes were Neonatal Intensive Care Unit admission, 5 minutes Apgar <7, 5 minute Apgar <4, Neonatal Intensive Care Unit length of stay, and neonatal antibiotic administration.

359 women were identified; 85 received antibiotics (ABX) and 274 did not (NO-ABX).
- Postpartum fever trended lower in the antibiotic group. Significantly fewer women in the antibiotic group were treated for postpartum endometritis.

- Neonatal Intensive Care Unit admission and neonatal antibiotic administration rates were higher in the antibiotic group.

- Five-minute Apgar <7 was more common in the antibiotic group.

- After controlling for age, gestational age, BMI, GBS status, delivery method, parity, presence of epidural, and receipt of acetaminophen, the odds of postpartum fever were reduced by a factor of 0.42 among those women who received antibiotics in comparison with those who did not.

While there was a lower rate of treatment for endometritis in women who received antibiotics for a single isolated maternal fever, there was a higher rate of Neonatal Intensive Care Unit admission and five-minute Apgar<7. This indicates the likely maternal benefit of antibiotic use, however, raises concern for neonatal risk.

American Journal of Obstetrics & Gynecology
Source: https://doi.org/10.1016/j.ajog.2021.07.020