Discussion on Lowered Fever Threshold in the Context of PROM

PROM occurs in approximately 10% of pregnancies and leads to a risk of IAI in women that is 3 times higher than that in non-PROM women. The risk of early-onset sepsis of neonates born to mothers exposed to PROM is 20 times higher than in non-PROM mothers. An increasing time period with PROM increases the risk of infection for both mothers and newborns accordingly. Nonetheless, the ACOG states that there is insufficient evidence to justify the routine use of prophylactic antibiotics with PROM at term in the absence of an indication for GBS prophylaxis (ACOG PB217). HOWEVER, now that the ACOG has provided a clinical practice update on IAI (JULY 2027), emphasizing that the traditional “requirement” of maternal temperature of 38 °C (100.4F) need NOT be present for IAI diagnosis, new data suggests that febrile and infectious morbidity may be increased with PROM after 12 hrs with “low grade” maternal temps. In this episode, we will review the ACOG clinical practice update (briefly, as we covered that previously) in light of a June 11, 2024 AJOG publication analyzing the relation between low-grade fever during prolonged rupture of membranes (>12 hours) at term and infectious outcomes.