Two-Dimensional Fever Burden during Labor—Peak, Duration, and Perinatal Outcomes

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However, the influence of fever intensity and duration during labour on perinatal outcomes remains inadequately understood.This retrospective case–control study analysed 400 term singleton deliveries (200 with intrapartum fever and 200 afebrile controls) at the First Affiliated Hospital of Kunming Medical University between January and December 2023. Maternal fever was defined as an axillary temperature ≥ 37.3°C. Peak intrapartum temperature was stratified into four categories (37.3–37.5°C, 37.5–38.0°C, 38.0–38.5°C, and ≥ 38.5°C), and fever duration was grouped as < 60 min, 60–120 min, 120–180 min, or ≥ 180 min. Maternal and neonatal outcomes were compared using multivariate logistic regression analyses.Baseline maternal characteristics did not differ between groups. The risks of caesarean delivery, postpartum haemorrhage, and puerperal infection increased sharply when maternal temperature reached ≥ 38.5°C (adjusted odds ratio [aOR] = 19.0, 95% CI 1.3–271.1; P < 0.05). Prolonged fever lasting ≥ 180 minutes was independently associated with higher odds of composite neonatal complications (aOR = 1.013 per hour, 95% CI 1.003–1.024; P < 0.05). The incidence of adverse outcomes rose significantly when maternal temperature exceeded 38°C or fever persisted beyond 180 minutes.Both high peak temperature (≥ 38.5°C) and prolonged fever (≥ 180 minutes) represent independent predictors of adverse perinatal outcomes. Continuous intrapartum temperature monitoring and timely intervention at these thresholds may improve maternal and neonatal prognosis. intrapartum fever labour maternal outcomes neonatal morbidity fever duration peak temperature Figures Figure 1 Figure 2 Introduction Intrapartum maternal fever is a significant obstetric complication, with incidence estimates ranging from 1.6% to 14.6% globally and affecting up to 20% of deliveries in some cohorts in the United States [ 1 – 4 ]. Such febrile episodes during labour have been consistently associated with negative perinatal consequences, including increased risk of operative delivery, postpartum haemorrhage, and neonatal morbidity [ 5 – 12 ]. Yet despite its prevalence and clinical relevance, the detailed dynamics of fever (in particular, peak temperature and duration) and their distinct impact on maternal and neonatal outcomes remain insufficiently characterised. Physiologically, labour-induced fever can arise from both infectious and non-infectious inflammatory processes. Notably, epidural analgesia has been implicated in the development of noninfectious maternal fever, mediated through sterile inflammatory pathways rather than overt infection. Evidence indicates that elevated maternal IL-6 levels before epidural placement are predictive of subsequent fever, even in the absence of clinical infection, supporting an inflammatory rather than an infectious origin [ 13 ]. Moreover, recent analyses suggest a time- and dose-dependent relationship between patient-controlled epidural analgesia and intrapartum maternal fever, highlighting the potential mechanistic link between analgesic method and thermoregulatory dysregulation [ 14 ]. Sterile inflammation in this context has been further implicated in increased oxidative stress, reduced heat dissipation, and altered thermoregulatory responses, all contributing to maternal hyperthermia [ 15 ]. Clinical investigations corroborate the association between epidural-related fever and adverse outcomes. One observational study noted that fevers among women receiving epidural analgesia were rarely attributable to infection, yet were correlated with elevated cytokine levels such as IL-6, consistent with non-infectious placental inflammation [ 16 ]. In parallel, animal studies using IL-6 infusions in late-term pregnant rats demonstrated that noninfectious hyperthermia alone can induce markers of neuroinflammation in fetal brain tissue, mimicking effects observed in human epidural-associated fever [ 17 ]. Despite these insights, critical gaps remain. Many existing studies treat intrapartum fever as a binary event, without stratifying by peak temperature intensity or the duration of fever exposure, and few adequately compare infectious vs noninfectious fever types. Moreover, data from Chinese populations are sparse, limiting regional generalisability. As such, the distinct contributions of fever severity and persistence to maternal and neonatal risk profiles remain poorly defined. To address these deficiencies, this retrospective case–control study of 400 term singleton deliveries in China systematically quantifies the independent and joint effects of two dimensions of intrapartum fever-peak maternal temperature and duration of fever exposure-on maternal and neonatal outcomes. By delineating temperature and time thresholds associated with heightened risk, we aim to improve risk stratification, guide clinical monitoring protocols, and optimise intervention strategies in labour management. Materials and Methods Study Design and Population This retrospective case–control study was performed in the Department of Obstetrics, The First Affiliated Hospital of Kunming Medical University, between 1 January and 31 December 2023. The source population comprised all term (≥ 37⁰/⁷ to ≤ 41⁶/⁷ weeks) singleton deliveries during the study period. Eligible participants were identified through electronic medical record review. Inclusion criteria were maternal age 18–45 years, singleton pregnancy, cephalic presentation, and labour (spontaneous or induced) culminating in vaginal delivery or caesarean section. Exclusion criteria included preterm delivery (< 37 weeks), multiple gestation, major fetal anomaly, intrauterine fetal demise, pre-existing maternal fever at labour onset (axillary temperature ≥ 37.3°C), severe systemic maternal disease (cardiac, hepatic, renal, or psychiatric), or incomplete records. Using these criteria, 400 women were included in the final analysis. Two hundred women who developed intrapartum fever comprised the case group, while 200 afebrile women were selected as controls at a 1:1 ratio using incidence-density sampling. For each case, one control who delivered within the same calendar month and had a gestational age matched within ± 7 days was randomly chosen from eligible afebrile parturients. This matching strategy minimised seasonal and gestational confounding effects [ 22 ]. Sample Size Justification Prior to data collection, a pragmatic sample size calculation was performed to ensure sufficient statistical power. Assuming α = 0.05 (two-sided) and 80% power (β = 0.20), and based on previous studies showing a 10–20% baseline incidence of composite adverse outcomes in term deliveries, an estimated 150–250 subjects per group were required to detect an odds ratio (OR) of approximately 2.0 [ 23 ]. Considering institutional case volume and study feasibility, a total of 400 participants (200 cases and 200 controls) was prespecified, providing adequate power to detect moderate-to-large effect sizes for key outcomes. Exposure Definition and Measurement Protocol Definition of intrapartum fever. Intrapartum fever was defined as an axillary maternal temperature ≥ 37.3°C recorded between the onset of labour and delivery, consistent with diagnostic thresholds used in previous Chinese and international research [ 18 , 19 ]. Categorisation. For stratified analysis, two temperature-related parameters were assessed: (1) Peak intrapartum temperature (highest axillary reading during labour), classified into four groups: 37.3–37.5°C, 37.5–38.0°C, 38.0–38.5°C, and ≥ 38.5°C; and (2) Duration of fever (interval between first temperature ≥ 37.3°C and temperature normalisation or delivery), divided into four categories: <60, 60–120, 120–180, and ≥ 180 minutes. Temperature measurement protocol. Maternal temperature was monitored using a calibrated digital axillary thermometer (accuracy ± 0.1°C), following standard clinical guidelines [ 20 , 21 ]. Measurements were performed every 30 minutes during active labour, and at 15-minute intervals after epidural analgesia initiation or once temperature exceeded 37.3°C. If fever persisted, the 15-minute interval was maintained until normothermia or delivery. The axilla was dried before measurement, and the probe was held in place for ≥ 5 minutes. Thermometer calibration was verified routinely under hospital quality control standards. Data Collection and Variables Clinical data were retrospectively extracted from the electronic maternity record system. Maternal variables included age, body mass index (BMI), parity, gestational age at delivery, and obstetric history. Pregnancy-related complications included hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), premature rupture of membranes (PROM), amniotic fluid disorders, Group B Streptococcus (GBS) colonisation, thyroid disease, anaemia, and autoimmune conditions. Intrapartum variables included total labour duration (stages I–II), PROM-to-delivery interval, number of vaginal examinations, induction of labour (duration ≥ 3 days), and use of epidural analgesia. Laboratory data such as white blood cell count, neutrophil percentage, and C-reactive protein were collected where available. Neonatal data included birthweight, Apgar scores, evidence of distress, respiratory distress, early-onset bacterial infection (≤ 72 h), sepsis, hypoxic–ischaemic encephalopathy (HIE), intracranial haemorrhage, neonatal intensive care unit (NICU) admission, and length of stay. Outcome Definitions Maternal outcomes comprised mode of delivery (spontaneous, assisted, or caesarean), postpartum haemorrhage (PPH; ≥500 mL vaginal or ≥ 1000 mL caesarean within 24 h), puerperal infection (clinical ± laboratory evidence), and postpartum hospital stay. A composite maternal adverse outcome was defined as the occurrence of any of these events. Neonatal outcomes included fetal distress, respiratory distress requiring oxygen or ventilation, early-onset infection, sepsis, HIE, intracranial haemorrhage, NICU admission, and hospital stay length. A composite neonatal adverse outcome was defined as the occurrence of any of these complications. Statistical Analysis Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA) [ 24 ]. Continuous variables were tested for normality using the Kolmogorov–Smirnov test. Normally distributed data were presented as mean ± standard deviation (SD) and compared using t-tests; non-normal data were summarised as median (interquartile range) and compared using the Mann–Whitney U test. Categorical variables were compared using the χ² test or Fisher’s exact test where appropriate. Univariate analyses were first conducted to identify variables potentially associated with adverse outcomes. Covariates with P < 0.10 in univariate screening and clinically important variables (e.g. age, BMI, parity, PROM, induction, epidural use) were included in multivariate logistic regression models following established methodological guidance [ 25 ]. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Multicollinearity was assessed using variance inflation factors (VIFs) [ 26 ], and model adequacy was evaluated using the Hosmer–Lemeshow goodness-of-fit test and the area under the receiver operating characteristic curve (AUC) [ 27 ]. A two-tailed P < 0.05 was considered statistically significant. Sensitivity and Subgroup Analyses Pre-planned subgroup analyses were conducted to evaluate the impact of potential confounders, including epidural-related noninfectious fever and prolonged PROM. Separate models were fitted for women with and without epidural analgesia, and for PROM durations ≤ 12 hours versus > 12 hours. Sensitivity analyses excluded cases with documented intrauterine or neonatal infection to verify whether associations persisted among likely noninfectious fevers. Ethics Statement This study was conducted in accordance with the ethical principles of the Declaration of Helsinki (as revised in 2013). Ethical approval was obtained from the Ethics Committee of the First Affiliated Hospital of Kunming Medical University (Approval No. 2023-OBG-012). Given the retrospective nature of the study and the use of anonymised clinical data, the requirement for written informed consent was waived by the Ethics Committee. Results 1. Study Population and Grouping The study selection and grouping process is illustrated in Fig. 1 . From January to December 2023, a total of 400 eligible term singleton pregnancies were included. Among these, 200 women who developed intrapartum fever comprised the fever group, and 200 afebrile women served as matched controls. The fever group was further stratified by peak temperature (37.3–37.5°C, 37.5–38.0°C, 38.0–38.5°C, and ≥ 38.5°C) and fever duration (< 60, 60–120, 120–180, and ≥ 180 min). Figgure1 Study flow and cohort construction (Jan–Dec 2023) The source population is all deliveries in 2023 at the First Affiliated Hospital of KMU (n = 400). Exclusions (n = 200) are listed as pre-labor fever (37.3°C), other systemic/genital infections, multiple gestations, elective cesarean section, and medical/psychiatric comorbidities. The analytic cohort (n = 400) comprises afebrile controls (n = 200; 1:1 randomly matched) and the intrapartum fever group (n = 200). Within the fever cohort, participants are further stratified by peak temperature—37.3–37.5°C (n = 28), 37.5–38.0°C (n = 120), 38.0–38.5°C (n = 42), and ≥ 38.5°C (n = 10)—and by fever duration—< 60 min (n = 67), 60–120 min (n = 50), 120–180 min (n = 33), and ≥ 180 min (n = 50). NICU, neonatal intensive care unit. 2. Baseline Characteristics No statistically significant differences were observed between the fever and control groups in maternal age, BMI, gestational age, parity, gravidity, or baseline laboratory values (P > 0.05). Table 1 Baseline Characteristics of Study Participants Fever group (n = 200) Non fever group (n = 200) statistic P value age 31.08 ± 4.32 31.34 ± 4.36 0.57 0.557 BMI 23.886 ± 1.932 23.826 ± 1.937 0.121 0.903 Delivery gestational week 38.87 ± 0.822 38.93 ± 0.900 0.696 0.487 gravidity 1(1, 2) 1(1, 2) 0.551 0.581 parity 0(0, 0) 0(0, 0.75) 0.952 0.341 White blood cell count upon admission (x10 9 /L) 8.33 ± 1.76 8.66 ± 1.75 0.274 0.601 Neutrophil percentage upon admission (%) 68.52 ± 5.59 69.50 ± 5.25 1.296 0.256 (Data are shown as mean ± SD or median (IQR). 3. Impact of Intrapartum Fever on Adverse Outcomes Women with intrapartum fever had significantly higher rates of caesarean delivery (12.0% vs 4.5%, P = 0.006) and longer postpartum hospital stay (median 2.0 vs 2.0 days, P < 0.001). Neonates born to febrile mothers had higher rates of early bacterial infection (6.5% vs 1.0%, P = 0.004) and NICU admission (9.5% vs 2.5%, P = 0.003). There were no significant differences in puerperal infection, postpartum haemorrhage, or neonatal HIE (P > 0.05). Table 2 Maternal Adverse Outcomes Fever group (n = 200) Non fever group (n = 200) statistic P value Caesarean section 24(12.00%) 9(4.50%) 7.431 0.006* Forceps Delivery 10(5.00%) 5(2.50%) 1.823 0.372 puerperal infection 4(2.00%) 1(0.50%) 1.823 0.372 PPH 6(3.00%) 4(2.00%) 0.41 0.522 Postpartum hospitalization days 2.00(2.00,2.00) 2.0(2.00,2.00) 3.339 <0.001* Adverse maternal outcomes 36(18.00%) 17(8.50%) 7.852 0.005* Table 3 Neonatal Adverse Outcomes Fever group (n = 200) Non fever group (n = 200) statistic P value Newborn birth weight (g) 3183.83 ± 242.86 3187.43 ± 252.60 0.145 0.885 Neonatal asphyxia 6(3.00%) 2(1.00%) 2.041 0.284 Early bacterial infection in newborns 13(6.50%) 2(1.00%) 8.381 0.004* hypoxic-ischemic encephalopathy 1(0.50%) 0(0.00%) 1.003 0.317 neonatal septicemia 2(1.00%) 0(0.00%) 2.010 0.156 Neonatal intracranial hemorrhage 7(3.50%) 2(1.00%) 2.842 0.092 Pediatric conversion rate 19(9.50%) 5(2.50%) 8.688 0.003* Adverse outcomes in newborns 19(9.50%) 5(2.50%) 8.688 0.003* (P < 0.05, statistically significant) 4. Impact of Peak Fever on Outcomes As peak maternal temperature increased, the rates of caesarean delivery, puerperal infection, and postpartum haemorrhage rose sharply (P < 0.05). Neonatal outcomes also deteriorated with increasing temperature, including higher rates of asphyxia, infection, hypoxic–ischaemic encephalopathy (HIE), intracranial haemorrhage, and NICU transfer. Table 4 Maternal Adverse Outcomes grouping 37.3 ≤ T<37.5℃(n = 28) 37.5℃≤T<38℃(n = 120) 38℃≤T<38.5℃(n = 120) T ≥ 38.5℃(n = 10) statistic P value Caesarean section 4(14.29%) 7(5.83%) 9(21.43%) 4(40.00%) 15.420 0.002* obstetric forceps 1(3.57%) 4(3.33%) 4(9.52%) 1(10.00%) 3.158 0.242 puerperal infection 0(0.00%) 1(0.83%) 1(2.38%) 2(20.00%) 17.966 0.017* PPH 0(0.00%) 2(1.67%) 2(4.76%) 2(20.00%) 1.978 0.025* Postpartum hospitalization days 2.00(2.00, 2.00) 2.00(2.00, 2.00) 2.00(2.00, 3.00) 3.00(2.75, 4.25) 33.163 <0.001* Adverse delivery outcomes for parturients 5(17.86%) 13(10.83%) 13(30.95%) 5(50.00%) 15.888 0.001* Table 5 Neonatal Adverse Outcomes grouping 37.3 ≤ T<37.5℃(n = 28) 37.5℃≤T<38℃(n = 120) 38℃≤T<38.5℃(n = 120) T ≥ 38.5℃(n = 10) statistic P value neonatal weight 3279.07 ± 255.56 3186.82 ± 237.39 3123.19 ± 235.95 3207.90 ± 412.66 2.195 0.090 Neonatal asphyxia 0(0.00%) 2(1.67%) 2(4.76%) 2(20.00%) 11.978 0.025* Early bacterial infection in newborns 1(3.60%) 5(4.20%) 3(7.14%) 4(40.00%) 19.964 <0.001* hypoxic-ischemic encephalopathy 0(0.00%) 0(0.00%) 0(0.00%) 1(10.00%) 19.095 <0.001* neonatal septicemia 0(0.00%) 1(0.83%) 0(2.38%) 1(0.00%) 8.004 0.046* Neonatal intracranial hemorrhage 0(0.00%) 1(0.83%) 3(7.14%) 3(30.00%) 25.984 <0.001* Number of pediatric transfers 1(3.60%) 8(6.70%) 6(14.30%) 4(40.00%) 14.204 0.003* Adverse outcomes in newborns 1(3.60%) 8(6.70%) 6(14.30%) 4(40.00%) 14.204 0.003* (P < 0.05, statistically significant) 5. Impact of Fever Duration on Outcomes While maternal adverse outcomes did not differ significantly by fever duration (P = 0.146), neonatal adverse outcomes increased with longer duration (P = 0.044). The ≥ 180-minute subgroup showed the highest NICU admission and infection rates. Table 6 Maternal Adverse Outcomes grouping 0min ≤ Duration of fever<60min(n = 67) 60min ≤ Duration of fever<120min(n = 50) 120min ≤ Duration of fever<180min(n = 33) Duration of fever ≥ 180min (n = 50) statistic P value Caesarean section 8(11.94%) 4(8.00%) 2(6.06%) 10(20.00%) 4.890 0.180 obstetric forceps 4(5.97%) 1(2.00%) 1(3.03%) 4(8.00%) 2.297 0.513 puerperal infection 0(0.00%) 1(2.00%) 0(0.00%) 3(6.00%) 6.122 0.106 postpartum hemorrhage 0(0.00%) 1(2.00%) 1(3.03%) 4(8.00%) 6.540 0.088 Postpartum hospitalization days 2.00(2.00, 2.00) 2.00(2.00, 2.00) 2.00(2.00, 2.00) 2.00(2.00, 3.00) 10.077 0.018* Adverse delivery outcomes for parturients 12(17.91%) 6(12.00%) 4(12.12%) 14(28.00%) 5.380 0.146 Table 7 Neonatal Adverse Outcomes grouping 0min ≤ Duration of fever<60min(n = 67) 60min ≤ Duration of fever<120min(n = 50) 120min ≤ Duration of fever<180min(n = 33) Duration of fever ≥ 180min (n = 50) statistic P value neonatal weight 3241.66 ± 276.21 3187.12 ± 234.26 3173.06 ± 210.69 3124.56 ± 253.60 2.133 0.097 Neonatal asphyxia 0(0.00%) 1(2.00%) 1(3.03%) 4(8.00%) 6.540 0.088 Early bacterial infection in newborns 0(3.60%) 6(12.00%) 1(3.03%) 6(12.00%) 10.289 0.016* hypoxic-ischemic encephalopathy 0(0.00%) 0(0.00%) 0(0.00%) 1(2.00%) 3.015 0.389 neonatal septicemia 0(0.00%) 0(0.00%) 1(3.03%) 1(2.00%) 3.061 0.382 Neonatal intracranial hemorrhage 0(0.00%) 3(6.00%) 0(0.00%) 4(8.00%) 7.550 0.056 Number of pediatric transfers 1(1.49%) 6(12.00%) 4(12.12%) 8(16.00%) 8.081 0.044* Adverse outcomes in newborns 1(1.49%) 6(12.00%) 4(12.12%) 8(16.00%) 8.081 0.044* (P < 0.05, statistically significant) 6. Multivariate Analysis After adjusting for potential confounders (PROM, epidural analgesia, number of vaginal examinations, etc.), a peak temperature ≥ 38.5°C remained an independent predictor of adverse maternal (aOR = 19.007, P = 0.030) and neonatal outcomes (aOR = 11.320, P = 0.006). Each 60-minute increase in fever duration was associated with a 1.3% higher risk of neonatal complications (aOR = 1.013, P = 0.013). Table 8 Maternal Adverse Outcomes Fever variable Number of people Number of cases OR value (95% CL) P value OR value (95% CL) ① P value Peak heat generation(℃) No fever 200 5 1.000 1.000 37.3-<37.5 28 1 1.444(0.163–12.835) 0.741 37.5-<38 120 8 2.786(0.890–8.721) 0.079 38-<38.5 43 6 6.500(1.883–22.473) 0.003 ≥ 38.5 10 4 26.000(5.543-121.949) <0.001 Increased peak fever 16.997(4.444–65.006) <0.001 19.007(1.333-271.051) 0.030 Duration of fever (min) No fever 200 17 1.000 1.000 0-<60 67 12 1.018(1.002–1.034) 0.024 60-<120 50 4 1.006(0.994–1.018) 0.339 120-<180 33 4 1.004(0.996–1.012) 0.365 ≥ 180 50 14 1.008(1.004–1.012) <0.001 Increased duration of fever 1.006(1.000-1.013) 0.053 1.007(0.999–1.015) 0.093 Table 9 Neonatal Adverse Outcomes Fever variable Number of people Number of cases OR value (95% CL) P value OR value (95% CL) ① P value Peak fever (℃) No fever 200 17 1.000 1.000 37.3-<37.5 28 5 2.340(0.789–6.942) 0.125 37.5-<38 120 13 1.308(0.611–2.798) 0.489 38-<38.5 43 13 4.826(2.122–10.973) <0.001 ≥ 38.5 10 5 10.765(2.831–40.926) <0.001 Increased peak fever 11.358(3.925–32.869) <0.001 11.320(2.013–63.670) 0.006 Duration of fever (min) No fever 200 5 1.000 1.000 0-<60 67 1 0.992(0.952–1.034) 0.703 60-<120 50 6 1.018(1.004–1.033) 0.014 120-<180 33 4 1.012(1.002–1.022) 0.014 ≥ 180 50 8 1.011(1.005–1.017) <0.001 Increased duration of fever 1.011(1.002–1.019) 0.015 1.013(1.003–1.024) 0.013 (P < 0.05, statistically significant) Discussion Diagnostic Challenges and Study Rationale A major obstacle in intrapartum fever research is the absence of uniform diagnostic criteria. The NICHD guidelines (2016) define fever as ≥ 39.0°C once or ≥ 38.0°C twice at 30-minute intervals [ 28 ], whereas many studies have adopted lower thresholds (≥ 37.5–38.0°C). To maximise sensitivity and align with domestic clinical practice, we used ≥ 37.3°C as the diagnostic threshold. Although this criterion broadens inclusion, it underscores the urgent need for internationally harmonised standards to enhance comparability and reduce diagnostic misclassification. Comparison With Previous Studies Our analysis demonstrated distinct patterns: maternal complications increased sharply when peak temperature exceeded 38.5°C, while neonatal morbidity correlated with fever lasting ≥ 180 minutes. This “threshold–duration” dual-axis model reconciles inconsistent findings from previous research, some of which associated outcomes with temperature alone [ 29 , 30 ] or fever duration [ 31 ]. Consistent with Burgess et al. [ 32 ], prolonged labour, induction, repeated vaginal examinations, and epidural analgesia emerged as independent risk factors. Maternal outcomes in this study—higher rates of caesarean delivery, postpartum haemorrhage, and puerperal infection—were in line with prior studies linking intrapartum fever to increased maternal morbidity [ 33 ]. Neonatal outcomes such as respiratory distress and early-onset sepsis also echoed earlier findings [ 34 , 35 ], while severe complications (asphyxia and hypoxic–ischaemic encephalopathy) appeared only in cases of high-grade fever, underscoring a temperature-threshold effect. Mechanistic Insights and Clinical Implications Mechanistically, maternal temperatures ≥ 38.5°C are thought to activate pro-inflammatory cytokine cascades (e.g., IL-6, TNF-α), impair uterine contractility, and induce uteroplacental hypoperfusion [ 36 , 37 ]. In contrast, prolonged fever duration imposes cumulative metabolic and oxidative stress on the placenta and foetus, potentially disrupting fetal oxygen delivery [ 38 ]. These findings suggest that intrapartum fever functions more as a risk marker than a direct cause, consistent with previous mechanistic studies linking epidural-related, non-infectious hyperthermia with inflammatory activation rather than microbial invasion [ 39 ]. Clinically, our results support a stratified management approach: when maternal temperature reaches ≥ 38.5°C or persists for ≥ 180 minutes, clinicians should intensify fetal monitoring, initiate active cooling and hydration, consider empirical antibiotics when infection is suspected, and reassess labour progress and delivery mode. For neonates, these thresholds can guide NICU admission decisions and infection screening. Such risk-adapted strategies balance timely intervention with the avoidance of unnecessary medical isation in mild, transient febrile cases,which following Fig. 2 . Limitations and Conclusions This single-centre, retrospective study is limited by potential confounding and regional practice variability. Long-term neurodevelopmental outcomes were not evaluated. Future multicentre, prospective studies are warranted to validate the proposed temperature and duration thresholds and refine risk-stratified management protocols. In summary, intrapartum fever should be conceptualised as a threshold- and duration-sensitive biomarker. Identifying ≥ 38.5°C and ≥ 180 minutes as clinically meaningful inflection points provides a foundation for standardised risk assessment and evidence-based clinical decision-making. Temperature ≥ 38.5 ° C indicated uterine dysfunction driven by inflammation, and duration ≥ 180 min indicated cumulative fetal metabolic stress. Recommended actions include intensified fetal monitoring, antipyretic therapy and hydration, empiric antibiotics if infection is suspe cted, and reassessment of labor progress with consideration of expedited delivery. In these cases, neonatal readiness need to be admitted to the NICU and early sepsis examination is needed. NICU, neonatal intensive care unit. Declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical principles of the Declaration of Helsinki (as revised in 2013). Ethical approval was obtained from the Ethics Committee of the First Affiliated Hospital of Kunming Medical University (Approval No. 2023-OBG-012). Given the retrospective nature of the study and the use of anonymised clinical data, the requirement for written informed consent was waived by the Ethics Committee. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received specific grant from National Natural Science Foundation of China(NSFC,Grant No.82260302) Authors ’ contributions Guangqiong Yang: manuscript writing and revision; Yue Zhang: data collection and statistical analysis; Zaiqing Qu: data analysis and figure preparation; Wenjin Qi: conceptual design, supervision, and critical manuscript revision. Rong Huang: clinical data acquisition and specimen management; All authors read and approved the final version of the manuscript. Acknowledgements The authors thank the Department of Obstetrics, The First Affiliated Hospital of Kunming Medical University, for their assistance and data support during this study. References Goetzl L. 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Intrapartum fever and the risk for perinatal complications—the effect of fever duration and positive cultures. Am J Obstet Gynecol. 2017;216(6):S408. doi:10.1016/j.ajog.2017.02.023 Yin H, Hu R. Risk factors of maternal intrapartum fever and the effect of fever duration on neonatal morbidity in different temperature groups. J Obstet Gynaecol Res. 2022;48(10):2522–2527. doi:10.1111/jog.15362 Burgess APH, Katz JE, Moretti M, Lakhi N. Risk factors for intrapartum fever in term gestations and associated maternal and neonatal sequelae. Gynecol Obstet Invest. 2017;82(5):508–516. doi:10.1159/000453611 Greenwell EA, Wyshak G, Ringer SA, Johnson LC, Rivkin MJ, Lieberman E. Epidural analgesia and intrapartum fever: maternal and neonatal outcomes. Obstet Gynecol. 2003;102(3):684–689. doi:10.1016/S0029-7844(03)00684-4 Edwards RK, Duff P. Intrapartum fever and neonatal outcome. Clin Perinatol. 2002;29(3):479–493. doi:10.1016/S0095-5108(02)00022-4 Wang H, Gao H, Chi H, et al. Maternal fever during labor and the risk of neonatal encephalopathy: duration and magnitude of hyperthermia. Obstet Gynecol. 2023;141(2):243–253. doi:10.1097/AOG.0000000000005272 Sultan P, David AL, Fernando R, Ackland GL. Inflammation and epidural-related maternal fever: proposed mechanisms. Anesth Analg. 2016;122(5):1546–1553. doi:10.1213/ANE.0000000000001193 Goetzl L. Epidural analgesia and maternal fever: a clinical and research update. Curr Opin Anaesthesiol. 2012;25(3):292–299. doi:10.1097/ACO.0b013e3283530dbe Buhimschi CS, Buhimschi IA. The role of cytokines in preterm labor and intrauterine infection. Semin Perinatol. 2006;30(1):33–42. doi:10.1053/j.semperi.2006.01.001 Riley LE, Celi AC, Onderdonk AB, et al. Association of epidural-related fever and non-infectious inflammation in term labor. Obstet Gynecol. 2011;117(3):588–595. doi:10.1097/AOG.0b013e31820b024d Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":99010,"visible":true,"origin":"","legend":"\u003cp\u003eStudy flow and cohort construction (Jan–Dec 2023)\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7839109/v1/aa99005aee5751a0b618b51e.png"},{"id":97268440,"identity":"c350856b-dfe7-4579-853b-450a4c317df4","added_by":"auto","created_at":"2025-12-02 14:46:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":118599,"visible":true,"origin":"","legend":"\u003cp\u003eDual-threshold action algorithm during labor\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7839109/v1/ba439be258c1239f62835883.png"},{"id":108601088,"identity":"003426cb-a1d7-494f-9ef4-cfadff22a6a7","added_by":"auto","created_at":"2026-05-06 11:28:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":751311,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7839109/v1/c2beb757-125d-48a6-90bf-5fbcadd24400.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Two-Dimensional Fever Burden during Labor—Peak, Duration, and Perinatal Outcomes","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntrapartum maternal fever is a significant obstetric complication, with incidence estimates ranging from 1.6% to 14.6% globally and affecting up to 20% of deliveries in some cohorts in the United States [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Such febrile episodes during labour have been consistently associated with negative perinatal consequences, including increased risk of operative delivery, postpartum haemorrhage, and neonatal morbidity [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9 CR10 CR11\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Yet despite its prevalence and clinical relevance, the detailed dynamics of fever (in particular, peak temperature and duration) and their distinct impact on maternal and neonatal outcomes remain insufficiently characterised.\u003c/p\u003e\u003cp\u003ePhysiologically, labour-induced fever can arise from both infectious and non-infectious inflammatory processes. Notably, epidural analgesia has been implicated in the development of noninfectious maternal fever, mediated through sterile inflammatory pathways rather than overt infection. Evidence indicates that elevated maternal IL-6 levels before epidural placement are predictive of subsequent fever, even in the absence of clinical infection, supporting an inflammatory rather than an infectious origin [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Moreover, recent analyses suggest a time- and dose-dependent relationship between patient-controlled epidural analgesia and intrapartum maternal fever, highlighting the potential mechanistic link between analgesic method and thermoregulatory dysregulation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Sterile inflammation in this context has been further implicated in increased oxidative stress, reduced heat dissipation, and altered thermoregulatory responses, all contributing to maternal hyperthermia [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eClinical investigations corroborate the association between epidural-related fever and adverse outcomes. One observational study noted that fevers among women receiving epidural analgesia were rarely attributable to infection, yet were correlated with elevated cytokine levels such as IL-6, consistent with non-infectious placental inflammation [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In parallel, animal studies using IL-6 infusions in late-term pregnant rats demonstrated that noninfectious hyperthermia alone can induce markers of neuroinflammation in fetal brain tissue, mimicking effects observed in human epidural-associated fever [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite these insights, critical gaps remain. Many existing studies treat intrapartum fever as a binary event, without stratifying by peak temperature intensity or the duration of fever exposure, and few adequately compare infectious vs noninfectious fever types. Moreover, data from Chinese populations are sparse, limiting regional generalisability. As such, the distinct contributions of fever severity and persistence to maternal and neonatal risk profiles remain poorly defined.\u003c/p\u003e\u003cp\u003eTo address these deficiencies, this retrospective case\u0026ndash;control study of 400 term singleton deliveries in China systematically quantifies the independent and joint effects of two dimensions of intrapartum fever-peak maternal temperature and duration of fever exposure-on maternal and neonatal outcomes. By delineating temperature and time thresholds associated with heightened risk, we aim to improve risk stratification, guide clinical monitoring protocols, and optimise intervention strategies in labour management.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eStudy Design and Population\u003c/p\u003e\u003cp\u003eThis retrospective case\u0026ndash;control study was performed in the Department of Obstetrics, The First Affiliated Hospital of Kunming Medical University, between 1 January and 31 December 2023. The source population comprised all term (\u0026ge;\u0026thinsp;37⁰/⁷ to \u0026le;\u0026thinsp;41⁶/⁷ weeks) singleton deliveries during the study period. Eligible participants were identified through electronic medical record review. Inclusion criteria were maternal age 18\u0026ndash;45 years, singleton pregnancy, cephalic presentation, and labour (spontaneous or induced) culminating in vaginal delivery or caesarean section. Exclusion criteria included preterm delivery (\u0026lt;\u0026thinsp;37 weeks), multiple gestation, major fetal anomaly, intrauterine fetal demise, pre-existing maternal fever at labour onset (axillary temperature\u0026thinsp;\u0026ge;\u0026thinsp;37.3\u0026deg;C), severe systemic maternal disease (cardiac, hepatic, renal, or psychiatric), or incomplete records.\u003c/p\u003e\u003cp\u003eUsing these criteria, 400 women were included in the final analysis. Two hundred women who developed intrapartum fever comprised the case group, while 200 afebrile women were selected as controls at a 1:1 ratio using incidence-density sampling. For each case, one control who delivered within the same calendar month and had a gestational age matched within \u0026plusmn;\u0026thinsp;7 days was randomly chosen from eligible afebrile parturients. This matching strategy minimised seasonal and gestational confounding effects [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSample Size Justification\u003c/p\u003e\u003cp\u003ePrior to data collection, a pragmatic sample size calculation was performed to ensure sufficient statistical power. Assuming α\u0026thinsp;=\u0026thinsp;0.05 (two-sided) and 80% power (β\u0026thinsp;=\u0026thinsp;0.20), and based on previous studies showing a 10\u0026ndash;20% baseline incidence of composite adverse outcomes in term deliveries, an estimated 150\u0026ndash;250 subjects per group were required to detect an odds ratio (OR) of approximately 2.0 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Considering institutional case volume and study feasibility, a total of 400 participants (200 cases and 200 controls) was prespecified, providing adequate power to detect moderate-to-large effect sizes for key outcomes.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eExposure Definition and Measurement Protocol\u003c/p\u003e\u003cp\u003eDefinition of intrapartum fever.\u003c/p\u003e\u003cp\u003eIntrapartum fever was defined as an axillary maternal temperature\u0026thinsp;\u0026ge;\u0026thinsp;37.3\u0026deg;C recorded between the onset of labour and delivery, consistent with diagnostic thresholds used in previous Chinese and international research [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCategorisation.\u003c/p\u003e\u003cp\u003eFor stratified analysis, two temperature-related parameters were assessed:\u003c/p\u003e\u003cp\u003e(1) Peak intrapartum temperature (highest axillary reading during labour), classified into four groups: 37.3\u0026ndash;37.5\u0026deg;C, 37.5\u0026ndash;38.0\u0026deg;C, 38.0\u0026ndash;38.5\u0026deg;C, and \u0026ge;\u0026thinsp;38.5\u0026deg;C; and\u003c/p\u003e\u003cp\u003e(2) Duration of fever (interval between first temperature\u0026thinsp;\u0026ge;\u0026thinsp;37.3\u0026deg;C and temperature normalisation or delivery), divided into four categories: \u0026lt;60, 60\u0026ndash;120, 120\u0026ndash;180, and \u0026ge;\u0026thinsp;180 minutes.\u003c/p\u003e\u003cp\u003eTemperature measurement protocol.\u003c/p\u003e\u003cp\u003eMaternal temperature was monitored using a calibrated digital axillary thermometer (accuracy\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u0026deg;C), following standard clinical guidelines [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Measurements were performed every 30 minutes during active labour, and at 15-minute intervals after epidural analgesia initiation or once temperature exceeded 37.3\u0026deg;C. If fever persisted, the 15-minute interval was maintained until normothermia or delivery. The axilla was dried before measurement, and the probe was held in place for \u0026ge;\u0026thinsp;5 minutes. Thermometer calibration was verified routinely under hospital quality control standards.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eData Collection and Variables\u003c/p\u003e\u003cp\u003eClinical data were retrospectively extracted from the electronic maternity record system. Maternal variables included age, body mass index (BMI), parity, gestational age at delivery, and obstetric history. Pregnancy-related complications included hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), premature rupture of membranes (PROM), amniotic fluid disorders, Group B Streptococcus (GBS) colonisation, thyroid disease, anaemia, and autoimmune conditions.\u003c/p\u003e\u003cp\u003eIntrapartum variables included total labour duration (stages I\u0026ndash;II), PROM-to-delivery interval, number of vaginal examinations, induction of labour (duration\u0026thinsp;\u0026ge;\u0026thinsp;3 days), and use of epidural analgesia. Laboratory data such as white blood cell count, neutrophil percentage, and C-reactive protein were collected where available. Neonatal data included birthweight, Apgar scores, evidence of distress, respiratory distress, early-onset bacterial infection (\u0026le;\u0026thinsp;72 h), sepsis, hypoxic\u0026ndash;ischaemic encephalopathy (HIE), intracranial haemorrhage, neonatal intensive care unit (NICU) admission, and length of stay.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eOutcome Definitions\u003c/p\u003e\u003cp\u003eMaternal outcomes comprised mode of delivery (spontaneous, assisted, or caesarean), postpartum haemorrhage (PPH; \u0026ge;500 mL vaginal or \u0026ge;\u0026thinsp;1000 mL caesarean within 24 h), puerperal infection (clinical\u0026thinsp;\u0026plusmn;\u0026thinsp;laboratory evidence), and postpartum hospital stay. A composite maternal adverse outcome was defined as the occurrence of any of these events.\u003c/p\u003e\u003cp\u003eNeonatal outcomes included fetal distress, respiratory distress requiring oxygen or ventilation, early-onset infection, sepsis, HIE, intracranial haemorrhage, NICU admission, and hospital stay length. A composite neonatal adverse outcome was defined as the occurrence of any of these complications.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were performed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Continuous variables were tested for normality using the Kolmogorov\u0026ndash;Smirnov test. Normally distributed data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and compared using t-tests; non-normal data were summarised as median (interquartile range) and compared using the Mann\u0026ndash;Whitney U test. Categorical variables were compared using the χ\u0026sup2; test or Fisher\u0026rsquo;s exact test where appropriate.\u003c/p\u003e\u003cp\u003eUnivariate analyses were first conducted to identify variables potentially associated with adverse outcomes. Covariates with P\u0026thinsp;\u0026lt;\u0026thinsp;0.10 in univariate screening and clinically important variables (e.g. age, BMI, parity, PROM, induction, epidural use) were included in multivariate logistic regression models following established methodological guidance [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Multicollinearity was assessed using variance inflation factors (VIFs) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and model adequacy was evaluated using the Hosmer\u0026ndash;Lemeshow goodness-of-fit test and the area under the receiver operating characteristic curve (AUC) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. A two-tailed P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSensitivity and Subgroup Analyses\u003c/p\u003e\u003cp\u003ePre-planned subgroup analyses were conducted to evaluate the impact of potential confounders, including epidural-related noninfectious fever and prolonged PROM. Separate models were fitted for women with and without epidural analgesia, and for PROM durations\u0026thinsp;\u0026le;\u0026thinsp;12 hours versus \u0026gt;\u0026thinsp;12 hours. Sensitivity analyses excluded cases with documented intrauterine or neonatal infection to verify whether associations persisted among likely noninfectious fevers.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eEthics Statement\u003c/p\u003e\u003cp\u003e This study was conducted in accordance with the ethical principles of the Declaration of Helsinki (as revised in 2013). Ethical approval was obtained from the Ethics Committee of the First Affiliated Hospital of Kunming Medical University (Approval No. 2023-OBG-012). Given the retrospective nature of the study and the use of anonymised clinical data, the requirement for written informed consent was waived by the Ethics Committee.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\n\u003ch3\u003e1. Study Population and Grouping\u003c/h3\u003e\n\u003cp\u003eThe study selection and grouping process is illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. From January to December 2023, a total of 400 eligible term singleton pregnancies were included. Among these, 200 women who developed intrapartum fever comprised the fever group, and 200 afebrile women served as matched controls. The fever group was further stratified by peak temperature (37.3\u0026ndash;37.5\u0026deg;C, 37.5\u0026ndash;38.0\u0026deg;C, 38.0\u0026ndash;38.5\u0026deg;C, and \u0026ge;\u0026thinsp;38.5\u0026deg;C) and fever duration (\u0026lt;\u0026thinsp;60, 60\u0026ndash;120, 120\u0026ndash;180, and \u0026ge;\u0026thinsp;180 min).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFiggure1 Study flow and cohort construction (Jan\u0026ndash;Dec 2023)\u003c/p\u003e\u003cp\u003eThe source population is all deliveries in 2023 at the First Affiliated Hospital of KMU (n\u0026thinsp;=\u0026thinsp;400). Exclusions (n\u0026thinsp;=\u0026thinsp;200) are listed as pre-labor fever (37.3\u0026deg;C), other systemic/genital infections, multiple gestations, elective cesarean section, and medical/psychiatric comorbidities. The analytic cohort (n\u0026thinsp;=\u0026thinsp;400) comprises afebrile controls (n\u0026thinsp;=\u0026thinsp;200; 1:1 randomly matched) and the intrapartum fever group (n\u0026thinsp;=\u0026thinsp;200). Within the fever cohort, participants are further stratified by peak temperature\u0026mdash;37.3\u0026ndash;37.5\u0026deg;C (n\u0026thinsp;=\u0026thinsp;28), 37.5\u0026ndash;38.0\u0026deg;C (n\u0026thinsp;=\u0026thinsp;120), 38.0\u0026ndash;38.5\u0026deg;C (n\u0026thinsp;=\u0026thinsp;42), and \u0026ge;\u0026thinsp;38.5\u0026deg;C (n\u0026thinsp;=\u0026thinsp;10)\u0026mdash;and by fever duration\u0026mdash;\u0026lt; 60 min (n\u0026thinsp;=\u0026thinsp;67), 60\u0026ndash;120 min (n\u0026thinsp;=\u0026thinsp;50), 120\u0026ndash;180 min (n\u0026thinsp;=\u0026thinsp;33), and \u0026ge;\u0026thinsp;180 min (n\u0026thinsp;=\u0026thinsp;50).\u003c/p\u003e\u003cp\u003eNICU, neonatal intensive care unit.\u003c/p\u003e\n\u003ch3\u003e2. Baseline Characteristics\u003c/h3\u003e\n\u003cp\u003eNo statistically significant differences were observed between the fever and control groups in maternal age, BMI, gestational age, parity, gravidity, or baseline laboratory values (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Characteristics of Study Participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFever group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon fever group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003estatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31.08\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.34\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.557\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.886\u0026thinsp;\u0026plusmn;\u0026thinsp;1.932\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.826\u0026thinsp;\u0026plusmn;\u0026thinsp;1.937\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.903\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDelivery gestational week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.822\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.900\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.696\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.487\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egravidity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(1, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1, 2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.551\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.581\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eparity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0, 0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0, 0.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.952\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.341\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite blood cell count upon admission (x10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.66\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.274\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.601\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeutrophil percentage upon admission (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68.52\u0026thinsp;\u0026plusmn;\u0026thinsp;5.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.296\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.256\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e(Data are shown as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or median (IQR).\u003c/p\u003e\n\u003ch3\u003e3. Impact of Intrapartum Fever on Adverse Outcomes\u003c/h3\u003e\n\u003cp\u003eWomen with intrapartum fever had significantly higher rates of caesarean delivery (12.0% vs 4.5%, P\u0026thinsp;=\u0026thinsp;0.006) and longer postpartum hospital stay (median 2.0 vs 2.0 days, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Neonates born to febrile mothers had higher rates of early bacterial infection (6.5% vs 1.0%, P\u0026thinsp;=\u0026thinsp;0.004) and NICU admission (9.5% vs 2.5%, P\u0026thinsp;=\u0026thinsp;0.003). There were no significant differences in puerperal infection, postpartum haemorrhage, or neonatal HIE (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal Adverse Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFever group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon fever group (n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003estatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaesarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24(12.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9(4.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.431\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.006*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eForceps Delivery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10(5.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(2.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.823\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.372\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epuerperal infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4(2.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(0.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.823\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.372\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePPH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6(3.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4(2.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.522\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostpartum hospitalization days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.00(2.00,2.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.0(2.00,2.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.339\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdverse maternal outcomes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36(18.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17(8.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.852\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.005*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNeonatal Adverse Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFever group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon fever group\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003estatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNewborn birth weight (g)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3183.83\u0026thinsp;\u0026plusmn;\u0026thinsp;242.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3187.43\u0026thinsp;\u0026plusmn;\u0026thinsp;252.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.885\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal asphyxia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6(3.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(1.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.041\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.284\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly bacterial infection in newborns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13(6.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(1.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.381\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.004*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ehypoxic-ischemic encephalopathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(0.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.317\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eneonatal septicemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(1.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal intracranial hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7(3.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(1.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.842\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.092\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePediatric conversion rate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19(9.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(2.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.688\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.003*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdverse outcomes in newborns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19(9.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(2.50%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.688\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.003*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, statistically significant)\u003c/p\u003e\n\u003ch3\u003e4. Impact of Peak Fever on Outcomes\u003c/h3\u003e\n\u003cp\u003eAs peak maternal temperature increased, the rates of caesarean delivery, puerperal infection, and postpartum haemorrhage rose sharply (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Neonatal outcomes also deteriorated with increasing temperature, including higher rates of asphyxia, infection, hypoxic\u0026ndash;ischaemic encephalopathy (HIE), intracranial haemorrhage, and NICU transfer.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal Adverse Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003egrouping\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.3\u0026thinsp;\u0026le;\u0026thinsp;T\u0026lt;37.5℃(n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.5℃\u0026le;T\u0026lt;38℃(n\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38℃\u0026le;T\u0026lt;38.5℃(n\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eT\u0026thinsp;\u0026ge;\u0026thinsp;38.5℃(n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003estatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaesarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4(14.29%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7(5.83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9(21.43%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4(40.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15.420\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eobstetric forceps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1(3.57%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4(3.33%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4(9.52%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1(10.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.242\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epuerperal infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(0.83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1(2.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2(20.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e17.966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.017*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePPH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2(1.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2(4.76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2(20.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.978\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.025*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostpartum hospitalization days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.00(2.00, 2.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.00(2.00, 2.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.00(2.00, 3.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.00(2.75, 4.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e33.163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdverse delivery outcomes for parturients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5(17.86%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13(10.83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13(30.95%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5(50.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e15.888\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNeonatal Adverse Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003egrouping\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.3\u0026thinsp;\u0026le;\u0026thinsp;T\u0026lt;37.5℃(n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.5℃\u0026le;T\u0026lt;38℃(n\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38℃\u0026le;T\u0026lt;38.5℃(n\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eT\u0026thinsp;\u0026ge;\u0026thinsp;38.5℃(n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003estatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eneonatal weight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3279.07\u0026thinsp;\u0026plusmn;\u0026thinsp;255.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3186.82\u0026thinsp;\u0026plusmn;\u0026thinsp;237.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3123.19\u0026thinsp;\u0026plusmn;\u0026thinsp;235.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3207.90\u0026thinsp;\u0026plusmn;\u0026thinsp;412.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.090\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal asphyxia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(1.67%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(4.76%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2(20.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e11.978\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.025*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly bacterial infection in newborns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(3.60%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(4.20%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3(7.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(40.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e19.964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ehypoxic-ischemic encephalopathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1(10.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e19.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eneonatal septicemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(0.83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(2.38%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.046*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal intracranial hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(0.83%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3(7.14%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3(30.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e25.984\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.001*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of pediatric transfers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(3.60%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(6.70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(14.30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(40.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e14.204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.003*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdverse outcomes in newborns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(3.60%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(6.70%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(14.30%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(40.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e14.204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.003*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, statistically significant)\u003c/p\u003e\n\u003ch3\u003e5. Impact of Fever Duration on Outcomes\u003c/h3\u003e\n\u003cp\u003eWhile maternal adverse outcomes did not differ significantly by fever duration (P\u0026thinsp;=\u0026thinsp;0.146), neonatal adverse outcomes increased with longer duration (P\u0026thinsp;=\u0026thinsp;0.044). The \u0026ge;\u0026thinsp;180-minute subgroup showed the highest NICU admission and infection rates.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal Adverse Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003egrouping\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0min\u0026thinsp;\u0026le;\u0026thinsp;Duration of fever\u0026lt;60min(n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60min\u0026thinsp;\u0026le;\u0026thinsp;Duration of fever\u0026lt;120min(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e120min\u0026thinsp;\u0026le;\u0026thinsp;Duration of fever\u0026lt;180min(n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDuration of fever\u0026thinsp;\u0026ge;\u0026thinsp;180min\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003estatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaesarean section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8(11.94%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4(8.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2(6.06%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10(20.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4.890\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.180\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eobstetric forceps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4(5.97%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(2.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1(3.03%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4(8.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.513\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epuerperal infection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(2.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3(6.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6.122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.106\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epostpartum hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1(2.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1(3.03%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4(8.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6.540\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.088\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostpartum hospitalization days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.00(2.00, 2.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.00(2.00, 2.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.00(2.00, 2.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.00(2.00, 3.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.018*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdverse delivery outcomes for parturients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12(17.91%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6(12.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4(12.12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e14(28.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5.380\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.146\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNeonatal Adverse Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003egrouping\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0min\u0026thinsp;\u0026le;\u0026thinsp;Duration of fever\u0026lt;60min(n\u0026thinsp;=\u0026thinsp;67)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60min\u0026thinsp;\u0026le;\u0026thinsp;Duration of fever\u0026lt;120min(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e120min\u0026thinsp;\u0026le;\u0026thinsp;Duration of fever\u0026lt;180min(n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDuration of fever\u0026thinsp;\u0026ge;\u0026thinsp;180min\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003estatistic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eneonatal weight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3241.66\u0026thinsp;\u0026plusmn;\u0026thinsp;276.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3187.12\u0026thinsp;\u0026plusmn;\u0026thinsp;234.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3173.06\u0026thinsp;\u0026plusmn;\u0026thinsp;210.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3124.56\u0026thinsp;\u0026plusmn;\u0026thinsp;253.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.097\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal asphyxia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(2.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3.03%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(8.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6.540\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.088\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly bacterial infection in newborns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(3.60%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(12.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3.03%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6(12.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10.289\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.016*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ehypoxic-ischemic encephalopathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1(2.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.389\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eneonatal septicemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(3.03%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1(2.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.382\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal intracranial hemorrhage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(6.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(8.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7.550\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of pediatric transfers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(1.49%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(12.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(12.12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8(16.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8.081\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.044*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdverse outcomes in newborns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(1.49%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(12.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(12.12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8(16.00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8.081\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.044*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, statistically significant)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003e6. Multivariate Analysis\u003c/h3\u003e\n\u003cp\u003eAfter adjusting for potential confounders (PROM, epidural analgesia, number of vaginal examinations, etc.), a peak temperature\u0026thinsp;\u0026ge;\u0026thinsp;38.5\u0026deg;C remained an independent predictor of adverse maternal (aOR\u0026thinsp;=\u0026thinsp;19.007, P\u0026thinsp;=\u0026thinsp;0.030) and neonatal outcomes (aOR\u0026thinsp;=\u0026thinsp;11.320, P\u0026thinsp;=\u0026thinsp;0.006). Each 60-minute increase in fever duration was associated with a 1.3% higher risk of neonatal complications (aOR\u0026thinsp;=\u0026thinsp;1.013, P\u0026thinsp;=\u0026thinsp;0.013).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal Adverse Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFever variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of people\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of cases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR value (95% CL)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR value (95% CL) ①\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeak heat generation(℃)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e37.3-\u0026lt;37.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.444(0.163\u0026ndash;12.835)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.741\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e37.5-\u0026lt;38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.786(0.890\u0026ndash;8.721)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.079\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e38-\u0026lt;38.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.500(1.883\u0026ndash;22.473)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;38.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26.000(5.543-121.949)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncreased peak fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.997(4.444\u0026ndash;65.006)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e19.007(1.333-271.051)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of fever (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0-\u0026lt;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.018(1.002\u0026ndash;1.034)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60-\u0026lt;120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.006(0.994\u0026ndash;1.018)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.339\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e120-\u0026lt;180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.004(0.996\u0026ndash;1.012)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.365\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.008(1.004\u0026ndash;1.012)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncreased duration of fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.006(1.000-1.013)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.007(0.999\u0026ndash;1.015)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.093\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNeonatal Adverse Outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFever variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of people\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNumber of cases\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR value (95% CL)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR value (95% CL) ①\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeak fever (℃)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e37.3-\u0026lt;37.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.340(0.789\u0026ndash;6.942)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e37.5-\u0026lt;38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.308(0.611\u0026ndash;2.798)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.489\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e38-\u0026lt;38.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.826(2.122\u0026ndash;10.973)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;38.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.765(2.831\u0026ndash;40.926)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncreased peak fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.358(3.925\u0026ndash;32.869)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e11.320(2.013\u0026ndash;63.670)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of fever (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0-\u0026lt;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.992(0.952\u0026ndash;1.034)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.703\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60-\u0026lt;120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.018(1.004\u0026ndash;1.033)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e120-\u0026lt;180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.012(1.002\u0026ndash;1.022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.011(1.005\u0026ndash;1.017)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncreased duration of fever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.011(1.002\u0026ndash;1.019)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.013(1.003\u0026ndash;1.024)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.013\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e(P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, statistically significant)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDiagnostic Challenges and Study Rationale\u003c/p\u003e\u003cp\u003eA major obstacle in intrapartum fever research is the absence of uniform diagnostic criteria. The NICHD guidelines (2016) define fever as ≥ 39.0°C once or ≥ 38.0°C twice at 30-minute intervals [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], whereas many studies have adopted lower thresholds (≥ 37.5–38.0°C). To maximise sensitivity and align with domestic clinical practice, we used ≥ 37.3°C as the diagnostic threshold. Although this criterion broadens inclusion, it underscores the urgent need for internationally harmonised standards to enhance comparability and reduce diagnostic misclassification.\u003c/p\u003e\u003cp\u003eComparison With Previous Studies\u003c/p\u003e\u003cp\u003eOur analysis demonstrated distinct patterns: maternal complications increased sharply when peak temperature exceeded 38.5°C, while neonatal morbidity correlated with fever lasting ≥ 180 minutes. This “threshold–duration” dual-axis model reconciles inconsistent findings from previous research, some of which associated outcomes with temperature alone [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] or fever duration [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Consistent with Burgess et al. [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], prolonged labour, induction, repeated vaginal examinations, and epidural analgesia emerged as independent risk factors.\u003c/p\u003e\u003cp\u003eMaternal outcomes in this study—higher rates of caesarean delivery, postpartum haemorrhage, and puerperal infection—were in line with prior studies linking intrapartum fever to increased maternal morbidity [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Neonatal outcomes such as respiratory distress and early-onset sepsis also echoed earlier findings [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], while severe complications (asphyxia and hypoxic–ischaemic encephalopathy) appeared only in cases of high-grade fever, underscoring a temperature-threshold effect.\u003c/p\u003e\u003cp\u003eMechanistic Insights and Clinical Implications\u003c/p\u003e\u003cp\u003eMechanistically, maternal temperatures ≥ 38.5°C are thought to activate pro-inflammatory cytokine cascades (e.g., IL-6, TNF-α), impair uterine contractility, and induce uteroplacental hypoperfusion [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In contrast, prolonged fever duration imposes cumulative metabolic and oxidative stress on the placenta and foetus, potentially disrupting fetal oxygen delivery [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. These findings suggest that intrapartum fever functions more as a risk marker than a direct cause, consistent with previous mechanistic studies linking epidural-related, non-infectious hyperthermia with inflammatory activation rather than microbial invasion [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eClinically, our results support a stratified management approach: when maternal temperature reaches ≥ 38.5°C or persists for ≥ 180 minutes, clinicians should intensify fetal monitoring, initiate active cooling and hydration, consider empirical antibiotics when infection is suspected, and reassess labour progress and delivery mode. For neonates, these thresholds can guide NICU admission decisions and infection screening. Such risk-adapted strategies balance timely intervention with the avoidance of unnecessary medical isation in mild, transient febrile cases,which following Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Limitations and Conclusions","content":"\u003cp\u003eThis single-centre, retrospective study is limited by potential confounding and regional practice variability. Long-term neurodevelopmental outcomes were not evaluated. Future multicentre, prospective studies are warranted to validate the proposed temperature and duration thresholds and refine risk-stratified management protocols. In summary, intrapartum fever should be conceptualised as a threshold- and duration-sensitive biomarker. Identifying ≥ 38.5°C and ≥ 180 minutes as clinically meaningful inflection points provides a foundation for standardised risk assessment and evidence-based clinical decision-making.\u003c/p\u003e\u003cp\u003eTemperature ≥ 38.5 ° C indicated uterine dysfunction driven by inflammation, and duration ≥ 180 min indicated cumulative fetal metabolic stress. Recommended actions include intensified fetal monitoring, antipyretic therapy and hydration, empiric antibiotics if infection is \u003cb\u003esuspe\u003c/b\u003ected, and reassessment of labor progress with consideration of expedited delivery. In these cases, neonatal readiness need to be admitted to the NICU and early sepsis examination is needed.\u003c/p\u003e\u003cp\u003eNICU, neonatal intensive care unit.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003cbr\u003e\u003c/strong\u003eThis study was conducted in accordance with the ethical principles of the Declaration of Helsinki (as revised in 2013). Ethical approval was obtained from the Ethics Committee of the First Affiliated Hospital of Kunming Medical University (Approval No. 2023-OBG-012). Given the retrospective nature of the study and the use of anonymised clinical data, the requirement for written informed consent was waived by the Ethics Committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003cbr\u003e\u003c/strong\u003eThe datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003cbr\u003e\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;This research received specific grant from National Natural Science Foundation of China(NSFC,Grant No.82260302)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;contributions\u003cbr\u003e\u003c/strong\u003eGuangqiong Yang: manuscript writing and revision;\u003cbr\u003e\u0026nbsp;Yue Zhang: data collection and statistical analysis;\u003cbr\u003e\u0026nbsp;Zaiqing Qu: data analysis and figure preparation;\u003cbr\u003e\u0026nbsp;Wenjin Qi: conceptual design, supervision, and critical manuscript revision. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Rong Huang: clinical data acquisition and specimen management;\u003cbr\u003e\u0026nbsp;All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003cbr\u003e\u003c/strong\u003eThe authors thank the Department of Obstetrics, The First Affiliated Hospital of Kunming Medical University, for their assistance and data support during this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGoetzl L. Intrapartum fever in term labor: epidemiology and outcomes. Clin Perinatol. 2016;43(3):585-596.\u003c/li\u003e\n\u003cli\u003eGreenwell EA, Wyshak G, Ringer SA, Johnson LC, Rivkin MJ, Lieberman E. Intrapartum temperature elevation, epidural use, and adverse outcome in term infants. Pediatrics. 2012;129(2):e447-e454.\u003c/li\u003e\n\u003cli\u003eLieberman E, Lang JM, Richardson DK, Frigoletto FD, Heffner LJ, Cohen A. Intrapartum maternal fever and neonatal outcome. Pediatrics. 2000;105(1 Pt 1):8-13.\u003c/li\u003e\n\u003cli\u003eRiley LE, Celi AC, Onderdonk AB, et al. Association of epidural-related fever and noninfectious inflammation in term labor. Obstet Gynecol. 2011;117(3):588-595.\u003c/li\u003e\n\u003cli\u003eSharma R, Young JL, Neu J. Molecular pathophysiology of intrapartum fever and inflammation. Am J Reprod Immunol. 2015;73(6):556-569.\u003c/li\u003e\n\u003cli\u003eBuhimschi CS, Buhimschi IA. The role of cytokines in preterm labor and intrauterine infection. 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Clin Perinatol. 2016;43(3):585\u0026ndash;596. doi:10.1016/j.clp.2016.04.009\u003c/li\u003e\n\u003cli\u003eNICE. Intrapartum care for healthy women and babies. NICE Guideline [CG190]. 2021.\u003c/li\u003e\n\u003cli\u003eACOG. Practice Bulletin No. 229: Intrapartum care of the term singleton. Obstet Gynecol. 2021;137(4):e91\u0026ndash;e111. doi:10.1097/AOG.0000000000004324\u003c/li\u003e\n\u003cli\u003eRothman KJ, Greenland S, Lash TL. Modern Epidemiology. 3rd ed. Lippincott Williams \u0026amp; Wilkins; 2008.\u003c/li\u003e\n\u003cli\u003eBiau DJ, Kern\u0026eacute;is S, Porcher R. Statistics in brief: the importance of sample size in the planning and interpretation of medical research. Clin Orthop Relat Res. 2008;466(9):2282\u0026ndash;2288. doi:10.1007/s11999-008-0346-9\u003c/li\u003e\n\u003cli\u003eIBM Corp. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp; 2011.\u003c/li\u003e\n\u003cli\u003eHosmer DW, Lemeshow S, Sturdivant RX. Applied Logistic Regression. 3rd ed. Wiley; 2013. doi:10.1002/9781118548387\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Brien RM. A caution regarding rules of thumb for variance inflation factors. Qual Quant. 2007;41(5):673\u0026ndash;690. doi:10.1007/s11135-006-9018-6\u003c/li\u003e\n\u003cli\u003eLemeshow S, Hosmer DW. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. 1982;115(1):92\u0026ndash;106. doi:10.1093/oxfordjournals.aje.a113284\u003c/li\u003e\n\u003cli\u003eNICHD Workshop Report. Executive summary: intrauterine infection and preterm labor. Am J Obstet Gynecol. 2016;214(1):B2\u0026ndash;B12. doi:10.1016/j.ajog.2015.10.039\u003c/li\u003e\n\u003cli\u003eHochler H, Lipschuetz M, Guedalia J, et al. The impact of peak and duration of maternal intrapartum fever on perinatal outcomes. Am J Obstet Gynecol MFM. 2021;3(5):100436. doi:10.1016/j.ajogmf.2021.100436\u003c/li\u003e\n\u003cli\u003eAshwal E, Salman L, Tzur Y, et al. Intrapartum fever and the risk for perinatal complications\u0026mdash;the effect of fever duration and positive cultures. Am J Obstet Gynecol. 2017;216(6):S408. doi:10.1016/j.ajog.2017.02.023\u003c/li\u003e\n\u003cli\u003eYin H, Hu R. Risk factors of maternal intrapartum fever and the effect of fever duration on neonatal morbidity in different temperature groups. J Obstet Gynaecol Res. 2022;48(10):2522\u0026ndash;2527. doi:10.1111/jog.15362\u003c/li\u003e\n\u003cli\u003eBurgess APH, Katz JE, Moretti M, Lakhi N. Risk factors for intrapartum fever in term gestations and associated maternal and neonatal sequelae. Gynecol Obstet Invest. 2017;82(5):508\u0026ndash;516. doi:10.1159/000453611\u003c/li\u003e\n\u003cli\u003eGreenwell EA, Wyshak G, Ringer SA, Johnson LC, Rivkin MJ, Lieberman E. Epidural analgesia and intrapartum fever: maternal and neonatal outcomes. Obstet Gynecol. 2003;102(3):684\u0026ndash;689. doi:10.1016/S0029-7844(03)00684-4\u003c/li\u003e\n\u003cli\u003eEdwards RK, Duff P. Intrapartum fever and neonatal outcome. Clin Perinatol. 2002;29(3):479\u0026ndash;493. doi:10.1016/S0095-5108(02)00022-4\u003c/li\u003e\n\u003cli\u003eWang H, Gao H, Chi H, et al. Maternal fever during labor and the risk of neonatal encephalopathy: duration and magnitude of hyperthermia. Obstet Gynecol. 2023;141(2):243\u0026ndash;253. doi:10.1097/AOG.0000000000005272\u003c/li\u003e\n\u003cli\u003eSultan P, David AL, Fernando R, Ackland GL. Inflammation and epidural-related maternal fever: proposed mechanisms. Anesth Analg. 2016;122(5):1546\u0026ndash;1553. doi:10.1213/ANE.0000000000001193\u003c/li\u003e\n\u003cli\u003eGoetzl L. Epidural analgesia and maternal fever: a clinical and research update. Curr Opin Anaesthesiol. 2012;25(3):292\u0026ndash;299. doi:10.1097/ACO.0b013e3283530dbe\u003c/li\u003e\n\u003cli\u003eBuhimschi CS, Buhimschi IA. The role of cytokines in preterm labor and intrauterine infection. Semin Perinatol. 2006;30(1):33\u0026ndash;42. doi:10.1053/j.semperi.2006.01.001\u003c/li\u003e\n\u003cli\u003eRiley LE, Celi AC, Onderdonk AB, et al. Association of epidural-related fever and non-infectious inflammation in term labor. Obstet Gynecol. 2011;117(3):588\u0026ndash;595. doi:10.1097/AOG.0b013e31820b024d\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"intrapartum fever, labour, maternal outcomes, neonatal morbidity, fever duration, peak temperature","lastPublishedDoi":"10.21203/rs.3.rs-7839109/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7839109/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntrapartum maternal fever is a frequent but clinically important event associated with increased maternal and neonatal morbidity. However, the influence of fever intensity and duration during labour on perinatal outcomes remains inadequately understood.This retrospective case\u0026ndash;control study analysed 400 term singleton deliveries (200 with intrapartum fever and 200 afebrile controls) at the First Affiliated Hospital of Kunming Medical University between January and December 2023. Maternal fever was defined as an axillary temperature\u0026thinsp;\u0026ge;\u0026thinsp;37.3\u0026deg;C. Peak intrapartum temperature was stratified into four categories (37.3\u0026ndash;37.5\u0026deg;C, 37.5\u0026ndash;38.0\u0026deg;C, 38.0\u0026ndash;38.5\u0026deg;C, and \u0026ge;\u0026thinsp;38.5\u0026deg;C), and fever duration was grouped as \u0026lt;\u0026thinsp;60 min, 60\u0026ndash;120 min, 120\u0026ndash;180 min, or \u0026ge;\u0026thinsp;180 min. Maternal and neonatal outcomes were compared using multivariate logistic regression analyses.Baseline maternal characteristics did not differ between groups. The risks of caesarean delivery, postpartum haemorrhage, and puerperal infection increased sharply when maternal temperature reached\u0026thinsp;\u0026ge;\u0026thinsp;38.5\u0026deg;C (adjusted odds ratio [aOR]\u0026thinsp;=\u0026thinsp;19.0, 95% CI 1.3\u0026ndash;271.1; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Prolonged fever lasting\u0026thinsp;\u0026ge;\u0026thinsp;180 minutes was independently associated with higher odds of composite neonatal complications (aOR\u0026thinsp;=\u0026thinsp;1.013 per hour, 95% CI 1.003\u0026ndash;1.024; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The incidence of adverse outcomes rose significantly when maternal temperature exceeded 38\u0026deg;C or fever persisted beyond 180 minutes.Both high peak temperature (\u0026ge;\u0026thinsp;38.5\u0026deg;C) and prolonged fever (\u0026ge;\u0026thinsp;180 minutes) represent independent predictors of adverse perinatal outcomes. Continuous intrapartum temperature monitoring and timely intervention at these thresholds may improve maternal and neonatal prognosis.\u003c/p\u003e","manuscriptTitle":"Two-Dimensional Fever Burden during Labor—Peak, Duration, and Perinatal Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 14:45:56","doi":"10.21203/rs.3.rs-7839109/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1347c909-e303-4885-ac3a-4c0808d8e434","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Withdrawn","date":"2026-05-06T11:21:45+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T11:27:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-02 14:45:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7839109","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7839109","identity":"rs-7839109","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}