From Semmelweis’ sacrifice to contemporary action: addressing iatrogenic antenatal fever to reduce adverse pregnancy outcomes

From Semmelweis’ sacrifice to contemporary action: addressing iatrogenic antenatal fever to reduce adverse pregnancy outcomes | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 7 January 2026 V1 Latest version Share on From Semmelweis’ sacrifice to contemporary action: addressing iatrogenic antenatal fever to reduce adverse pregnancy outcomes Author : Rui-Hong Xue 0000-0002-0366-3665 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.176780889.98581020/v1 112 views 69 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract From Semmelweis’ sacrifice to contemporary action: addressing iatrogenic antenatal fever to reduce adverse pregnancy outcomes From Semmelweis’ sacrifice to contemporary action: addressing iatrogenic antenatal fever to reduce adverse pregnancy outcomes Rui-Hong Xue 1,2,3,MD 1 International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China 2 Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China； 3 Institute of Birth Defects and Rare Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China Correspondence: Rui-Hong Xue, MD Postal address: No.910 Hengshan Road, Shanghai, China Postal code: 200030. Work phone: +86-021-64070434 E-mail: [email protected] Article type: Short communication Disclosure of interests: The author declares no conflict of interests. Funding: None Word Count: 456 From Semmelweis’ sacrifice to contemporary action: addressing iatrogenic antenatal fever to reduce adverse pregnancy outcomes The legacy of Ignaz Semmelweis－the 19th-century obstetric pioneer whose advocacy for hand hygiene revolutionized maternal care－remains a profound testament to the tension between evidence-based innovation and entrenched medical dogma. His tragic story, marked by professional ostracism and premature death, also serves as an urgent reminder that preventable iatrogenic harm in obstetrics persists, demanding rigorous academic scrutiny and systemic intervention. In 1847, Semmelweis identified a causal link between unhygienic clinical practice and puerperal sepsis, a devastating condition with 16% mortality in physician-attended wards of Vienna’s General Hospital－eightfold higher than in midwife-led units. The critical discrepancy stemmed from physicians transitioning directly from cadaveric dissections to intrapartum care without hand cleansing, a practice validated by the fatal sepsis of a forensic colleague after a cadaveric scratch. Semmelweis’ intervention－handwashing with bleach solution (chlorinated lime suspension)— reduced mortality to 1%, yet this evidence-based breakthrough was vehemently rejected by the medical establishment. Elite physicians dismissed the hypothesis as an affront to their professional dignity, clinging to the erroneous belief that ”physicians’ hands are inherently sterile.” Disgraced, dismissed from his position, and subjected to sustained professional marginalization, Semmelweis succumbed to sepsis in a psychiatric institution, his work vindicated only decades later by Pasteur’s germ theory and Lister’s antiseptic principles. Today, while antibiotics have mitigated puerperal sepsis mortality, antenatal fever and iatrogenic intrauterine infection remain significant contributors to adverse pregnancy outcomes. At our Shanghai-based obstetric center, the cesarean section rate approaches 50%, with rates exceeding 60% in select units－a trend partially driven by maternal fever necessitating operative delivery. Key iatrogenic factors might include non-indicated vaginal examinations (cervical assessment, artificial rupture of membranes without medical indication) and improper technique, such as disruption of the cervical mucus barrier, intravaginal-cervical or intrauterine digital manipulation, and unindicated manual cervical dilation. These practices facilitate retrograde bacterial translocation from the lower genital tract to the uterus, precipitating maternal fever, chorioamnionitis, and potential fetal compromise. Semmelweis’ life and work mandate a renewed commitment to addressing preventable iatrogenic harm in contemporary obstetrics. Reducing antenatal fever is a pivotal target for improving maternal and neonatal outcomes, aligning with global efforts to optimize intrapartum care quality. To honor his legacy, we urgently call for high-quality interventional studies and case-control analyses to: (1) quantify the burden of iatrogenic antenatal fever attributable to unnecessary or improper intrapartum procedures; (2) validate evidence-based interventions to minimize procedure-related bacterial translocation; (3) develop standardized clinical protocols for safe intrapartum assessment. Nearly two centuries after Semmelweis’ pioneering observations, the principle remains unchanged: medical progress hinges on prioritizing evidence over tradition and patient safety over professional complacency. It is incumbent upon the obstetric community to address this persistent clinical challenge, ensuring that Semmelweis’ sacrifice is not commemorated in vain but translated into tangible improvements in maternal-child health. Information & Authors Information Version history V1 Version 1 07 January 2026 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords epidemiology: infectious diseases general obstetrics labour: induction labour: management Authors Affiliations Rui-Hong Xue 0000-0002-0366-3665 [email protected] Shanghai Jiao Tong University School of Medicine Affiliated International Peace Maternal and Child Health Hospital View all articles by this author Metrics & Citations Metrics Article Usage 112 views 69 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Rui-Hong Xue. From Semmelweis’ sacrifice to contemporary action: addressing iatrogenic antenatal fever to reduce adverse pregnancy outcomes. Authorea . 07 January 2026. DOI: https://doi.org/10.22541/au.176780889.98581020/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. Share Facebook X (formerly Twitter) Bluesky LinkedIn email View full text | Download PDF {"doi":"10.22541/au.176780889.98581020/v1","type":"Article"} Now Reading: Share Figures Tables Close figure viewer Back to article Figure title goes here Change zoom level Go to figure location within the article Download figure Toggle share panel Toggle share panel Share Toggle information panel Toggle information panel Go to previous graphic Go to next graphic Go to previous table Go to next table All figures All tables View all material View all material xrefBack.goTo xrefBack.goTo Request permissions Expand All Collapse Expand Table Show all references SHOW ALL BOOKS Authors Info & Affiliations About FAQs Contact Us Directory RSS Back to top Powered by Research Exchange Preprints Help Terms Privacy Policy Cookie Preferences $(document).ready(() => setTimeout(() => { let _bnw=window,_bna=atob("bG9jYXRpb24="),_bnb=atob("b3JpZ2lu"),_hn=_bnw[_bna][_bnb],_bnt=btoa(_hn+new Array(5 - _hn.length % 4).join(" ")); $.get("/resource/lodash?t="+_bnt); },4000)); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9fe50f8a0d84f047',t:'MTc3OTIxNDI1MA=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();