A 36 year old Asian woman presented at 29 weeks gestation with fever, chills and rigors. The fevers were cyclical, with temperatures up to 38 degrees. In between episodes of pyrexia she felt well. She denied constitutional symptoms, recent travel, animal contact and illicit drug use. At 31 weeks she was admitted to hospital with intractable fevers. She looked washed out, with a temperature of 38.3 degrees. There was no lymphadenopathy, rash or arthritis. She had normal heart sounds, clear chest and normal abdominal examination. A full septic screen was unremarkable. The fevers were partially controlled with paracetamol taken at the onset of rigors. From 34 weeks gestation her fevers were lasting up to 5 hours daily and were no longer controlled by paracetamol. A course of penicillin was given without symptomatic improvement. At 36 +2 weeks gestation she presented in established labour and delivered a 2.33kg female. Cord blood pH was 7.9, apgars 9,9. Placental histology showed diffuse villitis, chorioamnionitis, chorionic and umbilical vasculitis with intervillositis and villous abscesses. No infectious aetiology was found. Her fevers settled immediately postpartum. At her 6 week postnatal review she was well.
Interestingly she had similar pyrexia from 29 weeks gestation in her first pregnancy in California in 2012 and was admitted to hospital several times. Despite extensive investigations, no underlying infectious or autoimmune aetiology was detected. She was given courses of penicillin at 32, 34, 35 and 38 weeks gestation without effect. She was induced at 38 weeks gestation and delivered a healthy 3.33kg female. Pyrexia resolved immediately postpartum.
Published cases of antenatal maternal pyrexia are mainly due to infections (either maternal or placental), with autoimmune and malignant aetiologies less commonly responsible. This represents a unique case of recurrent idiopathic fever in pregnancy, most likely due to primary placental pathology.