Nomogram for Perinatal Prediction of Intrapartum Fever: A Case-control Study

Abstract Objective: To explore the risk factors of intrapartum fever and develop a nomogram to predict the incidence of intrapartum fever.Methods: The general demographic characteristics and perinatal factors of 696 parturient who underwent vaginal delivery in the Affiliated Hospital of Xuzhou Medical University from May 2019 to April 2020 were retrospectively analyzed. 487 patients collected from May 2019 to October 2019 were formed into a training cohort. A multivariate logistic regression model was used to identify the independent risk factors associated with intrapartum fever during vaginal delivery, then a nomogram was developed to predict the occurrence. 209 cases collected from January 2020 to April 2020 were formed into a validation cohort to verify the nomogram.Results: Intrapartum fever was found in 72 of 487 parturient (14.78%) in the training cohort, and the incidence of intrapartum fever in the validation cohort was 14.83% (31/209). Multivariate logistic regression analysis showed that primiparas (Odds Ratio [OR]2.433; 95% confidence interval [CI]1.149-5.150), epidural labor analgesia (OR2.890; 95%CI 1.225-6.818), premature rupture of membranes (OR2.366; 95%CI 1.130-4.954), second stage of labor ≥120min (OR4.363; 95%CI 1.419-13.410), amniotic fluid pollution Ⅲ degree (OR10.391; 95%CI 3.299-32.729), fetal weight ≥4000g (OR7.492; 95%CI 2.115-26.542) were significantly related to intrapartum fever. According to clinical experience and previous studies, the duration of epidural labor analgesia also seemed to be a meaningful factor for intrapartum fever, so these 7 variables were incorporated to develop a nomogram, which achieved good area under ROC curve of 0.855 in the training cohort and 0.808 in the validation cohort, and it had a well-fitted calibration curve, which showed an excellent diagnostic performance.Conclusion: We constructed a model to predict the occurrence of fever during childbirth and developed an accessible nomogram. The nomogram can help doctors assess the risk of fever during childbirth, so as to lead to reasonable treatment measures.Clinical Trial Registration: (www.chictr.org.cn ChiCTR2000035593)