Monitoring Intrapartum Temperature: A Survey of Knowledge and Practice Amongst Obstetricians
SD Patel, A David, YM Liu, W Mon, R Fernando, P Sultan
University College London Hospital, London, UK
Introduction: Monitoring temperature is an integral part of maternal care during labour(1) as pyrexia is associated with adverse maternal and neonatal outcomes.(2) It is imperative that all members of the labour ward team can recognise and effectively treat intrapartum pyrexia (IP) to reduce morbidity and mortality associated with it. The aim of this survey was to evaluate knowledge about monitoring intrapartum temperature amongst obstetricians.
Methods: We invited members of the British Maternal & Fetal Medicine Society (BMFMS) to take part in an online questionnaire about monitoring intrapartum maternal temperature. Participants had 6 weeks to complete the survey, after which results were collated and analysed.
Results: There were 75 responses (11% response rate). Most responses (n=68, 91%) were from consultant obstetricians. The National Institute of Health and Care Excellence (NICE) recommendations of 4 hourly temperature monitoring during the 1 and 2 stages of labour were only recognised by 67% and 27% of respondents respectively. The complete and accurate definition of IP (as per NICE) was identified by 7% of respondents (Figure 1). Only 35% would advocate more frequent observations once IP is diagnosed, despite pyrexia being a cardinal sign of sepsis. 73% felt appropriate management of IP involved a combination of blood cultures, paracetamol and antibiotics. Body site used to monitor intrapartum temperature varied amongst hospital, with most (80%) using tympanic membrane. Other methods included sublingual (16%) and axillary (4%).
Discussion: Awareness amongst practicing obstetricians of the current recommendations about monitoring intrapartum temperature, especially during the 2 stage of labour is poor. These inaccuracies may lead to misdiagnosis and delayed treatment. Identifying and managing IP was also suboptimal amongst our respondents, with 26% not performing a combination of blood cultures, paracetamol and antibiotic therapy. Education for all labour ward staff, together with regular audit about management practices are needed to improve knowledge and treatment of intrapartum maternal pyrexia.
1. National Institute of Health and Care Excellence (2014) [Intrapartum Care: Care of Healthy Women and their Babies during Childbirth]. [CG190]. London. National Institute of Health and Care Excellence. www.nice.org.uk/guidance/cg190
2. MBRRACE-UK: Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK, 2014 www.npeu.ox.ac.uk/mbrrace-uk