In every mistake, there’s a lesson to be learned. Several times a year I have to review medical malpractice cases as it relates to obstetrics. Unfortunately, the same preventable mistakes occur over and over again. A recent case review brought home the importance of diagnosing and treating fevers aggressively as they relate to pregnant women, particularly if they’re in labor.
Any fever over 100°F needs to be investigated. Common colds don’t cause a fever. Bronchitis, Influenza (or the “flu”) and pneumonia do. A cold that is associated with body aches all over suggests the “flu” and needs immediate attention to prevent its progression to pneumonia. A cough associated with fever and backaches suggest pneumonia which requires aggressive antibiotic therapy. A cough associated with green or yellow phlegm suggests bronchitis, especially if there is a history of smoking. Right-sided lower back pain associated with a fever and frequency of urination suggests a kidney infection that needs antibiotic therapy. An untreated kidney infection can cause respiratory problems if not treated appropriately.
What happens if you break your water or “rupture” your membranes? The clock starts ticking. The amniotic sac that protects the baby is gone and it is now at risk for developing an infection. If the baby is premature, most clinicians will use a “wait and see” or conservative approach as long as the baby is not in jeopardy. The longer the baby remains inside the uterus, the better its chances of breathing once it’s born because its lungs will have an opportunity to develop. A woman could also be close to her due date, break her water but not have contractions. In both cases the patients should be admitted to the hospital to protect both mother and baby. There are two schools of thought regarding ruptured membranes. The pediatricians recommend starting the mother on antibiotic therapy if she has ruptured membranes for 18 hours or more. Some obstetricians prefer to wait until the patient actually develops a fever. At present, medical studies do not prescribed a hard fast rule favoring one method over the other. However, in the case that I reviewed, the baby unfortunately died because of significant infection and antibiotics had not been started until the mother developed a fever.
All fevers in pregnant women need to be aggressively treated with antibiotics in order to safeguard the baby. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.