Fever following misoprostol in terminations of pregnancy.

Nijman, T.A.J. (2013) Fever following misoprostol in terminations of pregnancy. thesis, Medicine.

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Abstract

Background: A termination of pregnancy (TOP) is common practice. This can be performed in a medical and a surgical way. For medical abortion in the second trimester the currently used method is the combination of mifepristone and misoprostol. Fever is a common side effect of misoprostol. In the indication TOP, fever as a primary outcome has not been investigated. The aim of this study was to determine the incidence of fever after administration of misoprostol for the indication termination of pregnancy (TOP) and to investigate which cases of fever are caused by an intra uterine infection (IUI) and which ones were side effects of misoprostol. The incidence of antibiotic therapy was investigated. Methods: A retrospective descriptive study was performed. Second trimester TOP with misoprostol occurring between January 2008 and October 2012 were selected. We included 403 cases and determined the incidence of fever. To exclude an infection as a probable cause for fever, reports of pathological examination of the placentas were reviewed for signs of infections. In addition, results of blood, vagina and urine cultures were noted. The use of epidural analgesia was noted. Statistical analysis was performed using non-parametric tests and logistic regression. Results: An incidence of 41% fever was found. A dose dependent relation was found between misoprostol and the presence of fever (logistic regression: p < 0.01; OR: 1,859; 95% CI: 1,258-2,746). The effect of epidural analgesia was not significant (p = 0.123; OR 0,317; 95% CI: 0,074-1,365). There was a significant relation between misoprostol and mean highest temperature, which was significantly higher in increased administered doses of misoprostol (p < 0.01). In patients with fever, 4% of the placentas showed signs of infection. None of the blood, urine or vaginal cultures showed a possible cause for fever. Antibiotic therapy was initiated in 19% of the patients with fever. Conclusion: Administration of misoprostol for the indication TOP is highly associated with fever during labor. In the majority of cases the presence of fever is a side effect and not a sign of an IUI. Therefore, antibiotic therapy is not indicated in most cases.

Item Type:	Thesis (Thesis)
Supervisor name:	Quartero, Dr. H.W.
Supervisor name:	Bakker, Dr. P.C.A.M. and gynaecologist, VUmc
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:07
Last Modified:	25 Jun 2020 11:07
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2698

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