Number of cervical examinations and risk of intrapartum maternal fever.

OBJECTIVE

To estimate the association between number of cervical examinations and risk of maternal fever during term labor and delivery.

METHODS

Within a 4-year retrospective cohort study of all consecutive term (37 weeks of gestation or more) singleton deliveries reaching the second stage of labor, we identified women who developed an intrapartum fever and compared them with women who remained afebrile through 6 hours postpartum. Primary exposure was number of digital cervical examinations. Extensive data were collected from the medical record, including obstetric and medical history, cervical examinations and timing, admitting diagnoses, and outcomes. Time-to-event analyses were used to account for length of labor. Cox proportional hazard models were developed adjusting for potentially confounding factors.

RESULTS

Of 2,395 women who were afebrile at admission, 174 (7.2%) developed an intrapartum fever. Women were examined one to 14 times. There was no significant association between increasing number of examinations and risk of fever. Even for the 505 women who had more than seven examinations during labor, there was no statistically significant increased risk of fever (hazard ratio 0.9, 95% confidence interval 0.4-2.0) compared with those with one to three examinations. Subanalyses by labor type and examinations after rupture of membranes also showed no significant association between number of cervical examinations and risk of intrapartum fever.

CONCLUSION

During term labor management, maternal fever risk is not significantly increased by the number of cervical examinations.

LEVEL OF EVIDENCE: II.