A Case Review of High Fevers Occurring after Administering Treatment for Postpartum Hemorrhage in Quito, Ecuador

B. Winikoff , G. Barrera, W. Leon, J. Durocher

Objective: This study documents the rise in body temperature in women who received either 800 micrograms of misoprostol sublingually or 40 IU of oxytocin to treat primary postpartum hemorrhage (PPH) in one site of our nine site double-blinded randomized controlled trial.

Materials and Methods: All women who received study treatment for diagnosed PPH were observed by nursing staff for side effects. If fever was observed, nurses measured the woman’s body temperature hourly until fever subsided. Fever was measured using an oral mercury thermometer and treated with acetaminophen, injectable aspirin, and cool compresses according to hospital protocol. Tympanic and digital oral thermometers were provided to nursing staff in order to compare the results from the mercury thermometer with those from the new electronic thermometers.

Results: Almost half the participants treated at this site (45%, 48/106) experienced an elevated body temperature (=38.0°C), of which 22% (23/106) had high fevers =40.0°C. (No other study site had more than one or two such cases.) For cases with high fever, the overall trend shows that fever sharply increased within one hour of treatment, peaked 1-2 hours after treatment, and gradually declined over a period of three hours. Temperatures remained above 40.0°C for less than two hours and measured below 38.0°C six hours after treatment. Moderate/severe shivering was commonly reported, and a few women were reported having delirium.

Conclusion: Although the incidence of high fever is higher than expected at this site, this secondary effect is transient, non-life threatening, and does not lead to prolonged hospitalization.