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ORIGINAL ARTICLE
Year : 2023  |  Volume : 22  |  Issue : 1  |  Page : 1-4  

Prospective study of pyrexia with pregnancy


Department of Obstetrics and Gynaecology, Smt. Shardaben Municipal General Hospital, Ahmedabad, Gujarat, India

Date of Submission25-Jul-2020
Date of Decision28-Jul-2021
Date of Acceptance08-Jun-2022
Date of Web Publication24-Jan-2023

Correspondence Address:
Paresh Naranbhai Panchal
51, Langhanaj Co Hou Soc, Opposite Kenya Hall, Chandlodiya, Ahmedabad - 382 481, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aam.aam_75_20

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   Abstract 


Objectives: Fever in pregnancy is a common clinical problem that increases the risk of morbidity for the mother and fetus. We studied variable medical complications of pregnant women suffering from fever and possible fetal complications. Materials and Methods: A prospective observational study of pyrexia with pregnancy in 50 patients admitted to our hospital irrespective of age, parity, reproductive characteristics, and socioeconomical conditions. Results: First, the majority group of the patients were of urinary tract infections and upper respiratory tract infections. The second majority group of the patients were of malaria, dengue, enteric fever, and pyrexia of unknown origin. Most of the etiologies of pyrexia were preventable. The majority of the patients had a low and moderate grade of pyrexia. Small for gestational age was the most common adverse pregnancy outcome and there were six perinatal deaths. Conclusion: Our study depicts that a wide range of maternal medical complications, as well as fetal and neonatal complications, occur due to pyrexia in pregnancy from various etiology.

   Abstract in French 

Résumé
Objectifs: La fièvre pendant la grossesse est un problème clinique courant qui augmente le risque de morbidité pour la mère et le fœtus. Nous avons étudié les complications médicales variables des femmes enceintes souffrant de fièvre et d'éventuelles complications fœtales. Matériaux et Méthodes: Une étude observationnelle prospective de la pyrexie avec une grossesse chez 50 patients admis dans notre hôpital, quel que soit l'âge, la parité, les caractéristiques reproductives et les conditions socioéconomiques. Résultats: Premièrement, le groupe majoritaire des patients était des infections des voies urinaires et des infections des voies respiratoires supérieures. Le deuxième groupe majoritaire des patients était de paludisme, de dengue, de fièvre entérique et de pyrexie d'origine inconnue. La plupart des étiologies de la pyrexie étaient évitables. La majorité des patients avaient un grade de pyrexie faible et modéré. Petit pour l'âge gestationnel était le résultat de la grossesse défavorable le plus courant et il y a eu six décès périnataux. Conclusion: Notre étude montre qu'un large éventail de Les complications médicales, ainsi que les complications fœtales et néonatales, se produisent en raison de la pyrexie pendant la grossesse de diverses étiologies.
Mots-clés: Grossesse, résultats de la grossesse, pyrexie, petite pour l'âge gestationnel

Keywords: Pregnancy, pregnancy outcome, pyrexia, small for gestational age


How to cite this article:
Mewada BN, Gandhi D, Diwan F, Panchal PN. Prospective study of pyrexia with pregnancy. Ann Afr Med 2023;22:1-4

How to cite this URL:
Mewada BN, Gandhi D, Diwan F, Panchal PN. Prospective study of pyrexia with pregnancy. Ann Afr Med [serial online] 2023 [cited 2023 Jan 28];22:1-4. Available from: https://www.annalsafrmed.org/text.asp?2023/22/1/1/368414




   Introduction Top


Pyrexia in pregnancy is a common clinical problem.

The risk to the mother and fetus is significantly increased in pregnancy, complicated by infection and fever.

Maternal immune function is usually decreased in normal pregnancy and many of the potent antibiotics should be used with caution in pregnant women due to the risk of teratogenicity.[1]

Mechanisms of hyperthermia-induced fetal damage included “cell death, membrane disruption, vascular disruption, placental infarction, etc.”[2]

Modest elevation in temperature before implantation and more sustained elevation during early embryogenesis may cause fetal death and abortion.[2]

Embryos that survive maternal hyperthermia during early development are at risk for a host of congenital anomalies.[3]

Temperature elevation during the second and third trimesters may still put the baby in jeopardy, particularly for central nervous system damage and might be responsible for premature labor and may precipitate preeclampsia.[4]

Aims and objectives

In the abovestated study, the following objectives are set forth:

  1. To determine the different etiological factors of pyrexia with pregnancy
  2. To know the effect of pyrexia on fetal and maternal outcome
  3. To assess the magnitude and nature of infections through laboratory diagnosis.



   Materials and Methods Top


The present study was a prospective observational study conducted in the department of obstetrics and gynecology.

A total of 50 patients with pyrexia and pregnancy were admitted. They were interviewed through a predesigned and pretested schedule after obtaining their informed consent.

The patients were selected at random irrespective of their age, parity, reproductive characteristics, and socioeconomical conditions.

The patients were followed up from enrollment in the study till discharge. The intrapartum as well as postpartum and maternal and fetal outcomes were assessed.


   Observation and Discussion Top


Etiological factors of pyrexia in pregnancy [Table 1]
Table 1: Etiological factors of pyrexia in pregnancy

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  • The above table shows different etiological factors of pyrexia with pregnancy
  • It shows more number of patients are of urinary tract infections (UTIs) (26.5%) which is comparable with Biswas et al.[5] (21.3%) and Nath et al. (20%). It is the effect of pregnancy on the urinary tract defense that makes pregnant women vulnerable to UTIs
  • Escherichia coli was the most common organism found in UTIs. In comparison with Biswas et al.,[5] (12.4%) more cases of upper respiratory tract infection (URTI) (24%) were due to environmental factors
  • Cases of pyrexia of unknown origin (PUO) are high which might be due to viral illness
  • In our study, there were 14% of cases of malaria which were not compatible with Biswas et al.[5] (35%) due to epidemiological factors.


Grade of pyrexia [Table 2]
Table 2: Grade of pyrexia

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  • The above table shows the number of patients with different grades of pyrexia
  • It shows that 65.5% of patients are of low-grade pyrexia, 34.5% of patiens are of moderate-grade pyrexia and no patient had high-grade pyrexia in our study
  • Most of the patients with low-grade pyrexia were due to URTI, PUO, enteric fever, and tuberculosis (TB)
  • Patients with moderate-grade fever had malaria, UTIs, and dengue.


The maternal medical complication of pyrexia with pregnancy [Table 3]
Table 3: The maternal medical complication of pyrexia with pregnancy

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  • The above table shows various medical complications that occurred in pregnant women with pyrexia
  • Overall anemia was the most common complication (36 cases)[6]
  • Out of 36 cases of anemia, eight cases were of severe anemia
  • Other cases included pleural effusion (2%), pneumonia (2%), and dengue hemorrhagic fever (2%). These complications were due to specific etiologies.[6]


Distribution of fetal outcome according to the etiology of fever [Table 4]
Table 4: Fetal outcome according to the etiology

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  • A total of 50 patients have studied out of which two patients' fetal outcome was not available because they were delivered outside
  • The above table shows hepatitis has a maximum adverse fetal outcome
  • In UTIs adverse outcome is 63.6%
  • In the case of PUO, there were 75% small for gestational age babies because in PUO the majority of adverse outcomes might be due to the presence of other factors such as anemia, previous preterm, and previous abortion.
  • All cases of gestation corrected age (GCA) babies were observed in malaria
  • In all cases of GCA babies, there was a history of pyrexia in the first trimester as it affects the development of the embryo in utero
  • Hepatitis, UTIs, and malaria are associated with more adverse fetal outcomes.[7] More aggressive management is to be done for the prevention of such outcome
  • The total adverse fetal outcome was seen in 64.6% of the cases
  • Hence, it can be hypothesized that hyperthermia relates to the changes in the uterine environment which can affect fetal well-being.[7]


Total fetal outcome in pyrexia with pregnancy [Table 5]
Table 5: Total fetal outcome in pyrexia with pregnancy

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  • It shows that 12% of the cases of pyrexia in pregnancy have fetal death which included miscarriage, IUD, and stillbirth
  • Our study is not compatible with Anderson et al.[8] where only 4.8% of cases had fetal death, which is due to the sample size of our study. The study done by Anderson et al. included a large number of patients.



   Conclusion Top


Following a prospective study of pyrexia with pregnancy in 50 cases, the following could be concluded.

  • The admission rate of pyrexia with pregnancy was 1.8% of antenatal indoor patients
  • The majority of the patients belong to the poor and middle socioeconomic class
  • Air- and vector-borne diseases were commonly present in patients as well as family member
  • The first majority group of patients were of UTIs and URTIs. The second majority group of patients were of malaria, dengue, enteric fever, and PUO. Most of the etiologies of pyrexia were preventable. The majority of the patients had low and moderate grades or pyrexia
  • Anemia was the most common complication observed with pyrexia in pregnancy. It may be due to nutritional deficiencies or due to infection but most of the cases of severe anemia were observed in malaria, pneumonia, and pleural effusion in respiratory infection. No statistical associations were observed between demographic characteristics and maternal medical complications
  • The specific maternal medical complication rate was higher in TB, lower respiratory tract infection, malaria, and dengue. The adverse fetal outcome was observed in cases of hepatitis, PUO, UTIs, and malaria. Fetal complications were numerous than maternal complications. All GCA fetuses had a history of pyrexia in the first trimester of pregnancy
  • Total fetal wastage was higher in comparison to the general group of patients. No maternal mortality was noted in our study.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Guyton AC, Hall JE. Textbook of Medical Physiology. 10th ed. W.B. Saunders, Philadelphia; 2000. p. 889-901.  Back to cited text no. 1
    
2.
Gibbs RS, Sweet RL. Maternal and fetal infections. Maternal-fetal medicine. In: Principles and Practice. Philadelphia: WB Saunders; 1989. p. 656-725.  Back to cited text no. 2
    
3.
Collier SA, Rasmussen SA, Feldkamp ML, Honein MA; National Birth Defects Prevention Study. Prevalence of self-reported infection during pregnancy among control mothers in the National Birth Defects Prevention Study. Birth Defects Res A Clin Mol Teratol 2009;85:193-201.  Back to cited text no. 3
    
4.
Rolbin SH, Morningstrar BA. The febrile parturient. In: Textbook of Obstetric Anaesthesia. New York: Churchill Livingstone; 1999. p. 375-91.  Back to cited text no. 4
    
5.
Biswas J, Banerjee K, Sanyal P, Datta M, Choudhury S, Dasgupta S, et al. Fetomaternal outcome of pyrexia in pregnancy: A prospective study. IJWHR 2015;3:132-5.  Back to cited text no. 5
    
6.
Morlen NH, Gunnes N, Magnus P, Jacobsson B. Risk of spontaneous preterm delivery in a low-risk population: The impact of maternal febrile episodes, urinary tract infection, pneumonia and ear-nose-throat infections (ENT). Eur J Obstet Gynecol Reprod Biol 2011;159:310-4.  Back to cited text no. 6
    
7.
Graham JM Jr. Marshall J. Edwards: Discoverer of maternal hyperthermia as a human teratogen. Birth Defects Res A Clin Mol Teratol 2005;73:857-64.  Back to cited text no. 7
    
8.
Andersen AM, Vastrup P, Wholfahrt J, Andersen PK, Olsen J, Melbye M. Fever in pregnancy band risk of fetal death: A cohort study. Lancet 2002;360:1552-6.  Back to cited text no. 8
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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