Fever and pregnancy

In Encyclopedia by Camille Masse Views: 6

Fever (defined by a rectal temperature above or equal to 38 ° C) is a common symptom during pregnancy, about 15% of cases. Although often benign, it must always be a doctor because of the risks it poses to the mother, pregnancy, and the child.

These risks are rarely threatening for the mother, but depend on the cause of the fever. The fetal risk is threefold: maternal-fetal infection with Neonatorum infection, the threat of premature birth, and the embryofœtopathies.

Course

The examination

• Say fever: taking rectal temperature.
• Learn about seniority, its intensity, its evolution.
• Consult the health record and search for vaccinations, the status (rubella, toxoplasmosis, syphilis, AIDS, etc),
• Monitoring of pregnancy, recent consultations,
• Concept of contact with infected close, recent trip (particularly in wetland area).
• Recent drug taken,
• And of course felt functional signs

The signs that should alert any particularly are: rupture of the pocket of the waters, the reduction or disappearance of the active movements of the fetus, and the appearance of uterine contractions.

Review

• Making of the vital constants (blood pressure, pulse, weight)
• Fundal height, fetal heart rate, fetal ultrasound for any doubt
• Speculum examination: research of a flow of liquid and pock-amnionitis signs
• Vaginal induced pain and cervical changes referring to a threat of preterm birth.
• Recording of the fetal heart rate.

Biological reviews

• CBC, CRP (sedimentation rate has no interest during pregnancy)
• Infectious balance: ECBU, blood cultures with specific research of Listeria monocytogenes (other reviews the taken orientation: radio chest, lumbar puncture, radio of the abdomen, kidney ultrasound, etc.)

Etiology

Chorioamnionitis

It is an infection of the placenta (and amniotic fluid) causing premature rupture of the bag of waters. The clinical picture is dominated by a fever, abdominal pain, vaginal discharge of dirty liquid, tinted, see frankly purulent or more abundant than to ordinary but clear and odourless. There is often fetal distress, the risk of infection Neonatorum is major. Fever is not necessarily feel in pregnant women. Responsible for germ is not always (see rarely) found during reviews, however it causes quickly extremely brutal contractions and rupture of the water Pocket that leads the work to avoid that this infection was worsening maternal level. It is an unstoppable phenomenon common in twin pregnancies. If pain in the lower abdomen or back are being felt, recalling the menstrual pain, even in irregular but more intense ways, he is Adviser to consult a doctor. The pain may be confused with ligament pain or positional pain, common symptoms associated with pregnancy.

Tocolysis contraindicated formellent, the treatment is based on the urgent fetal extraction by caesarean section, associated with intravenous antibiotics for the mother.

Despite a preterm birth (miscarriage, miscarriage late) linked to a chorio-amniotic acute, there is no particular risk for a new pregnancy (no recurrence of the disease since it is linked to a germ infection).

Listeria monocytogenes infection

see Listeriosis.

Acute pyelonephritis

Association of microbial nephropathy, a pyélite and a urinary tract infection is the most common cause, suspected before lumbar pain and a positive ECBU.

Acute appendicitis

Frequent and more difficult diagnosis: the rise of the Appendix caused by the development of uterus gives of the pain of the flank, sometimes even the right epigastrium. The treatment is surgical, under cœlioscopie.

Other causes

• Pancreatitis
• Hepatitis
• Meningitis
• Acute cholecystitis
• Malaria
• Group B streptococcal infection

etc.

Treatment

Keep in mind that any fever during pregnancy is evidence to the contrary, a Listeriosis. To do this, the initial balance sheet will necessarily include blood cultures with specific research of Listeria, and then is started, outside of other obvious cause, antibiotic treatment with amoxicillin (or erythromycin allergic to Penicillins), pending the outcome of further tests. Outside of a threat of preterm birth, treatment is ambulatory. He added of antipyretics (type paracetamol), and a good hydration (drink 2 litres of water a day).