Pregnant fever has an impact on fetal well-being, causing abnormal fetal heart rate (FHR). Effects of fever on the fetus in the uterus, depending on the high degree of maternal body temperature and the duration of fever. It has become a clinical procedure to reduce maternal temperature by administering medical paracetamol therapy. To increase the speed and amount of decrease in maternal body temperature by giving a combination of paracetamol and warm water compress (WWC). Paracetamol lowers core temperature. WWC on the peruut wall can reduce surface body temperature and can create a lower fetal ambient temperature, thereby facilitating the transfer of fetal body heat to the environment where the fetus lives.
To see the effect of giving a combination of paracetamol medical therapy and warm water compresses 34-37°C to decrease body temperature and improve the frequency of fetal heart rate
This research is a
Analysis results, a combination of medical therapy for paracetamol 500 mg/oral and WWC 34-37 °C on the abdominal wall and lower back can reduce the degree of body temperature fever by 1.3 °C can accelerate the decrease in body temperature 10 minutes faster than the control group that only decreased 0.9 °C. The decrease in maternal body temperature in the intervention group, affects the improvement in the frequency of FHR on average 16x /minute reaching normal within 20 minutes earlier. The decrease in temperature and frequency of FHR occurred in both groups and the results of the test did not differ significantly between groups, decreasing temperature p = 0.210 and improving the frequency of FHR p = 0.688.
The combination of paracetamol and WWC medical therapy, clinically reduced the degree of body temperature by a difference of 10 minutes better and returned the normal FHR value 20 minutes earlier than the control group.
Fetal distress occurs because the fetus does not receive enough oxygen in the uterus, [1.2] with abnormal frequency of Fetal Heart Rate (FHR). This can be caused by fever [3] (body temperature ≥37.8°C), [4] which is caused by obstetrics and non obstetrics.[5] Fever causes unstable blood flow to the fetus, the needs of the fetus are affected.[6,7] The process of infection, causes the body the fetus has a hypertherm. The high heat supply of the body causes the fetal body heat to be unable to move to the central circulation and to the abdominal wall of the mother. [8] Fever can occur in 10.5% of all pregnant women, [9.11-13 often occurs in the second and third trimesters, [11] most occur in the third trimester (70.8%). [8, 11, 14] Severity due to fever in pregnant women depending on the height of the mother's temperature, the length and time of fever [8, 15] The impact of fever can cause congenital defects, [9, 16] premature rupture of membranes, premature birth, [9, 11] impaired growth, [6, 17] asphyxia, [18-20] errors, fetal health problems to outside the uterus, [20] fetal deaths [21] and infants aged 0-12 months. [3] This contributes to the rate of morbidity and mortality of the fetus. [5, 18]
To reduce the adverse effects of fever in pregnant women, it requires proper and fast management to overcome hypoxia. [22, 23] Fetal distress in pregnant women with fever, managed by administering intravenous intravenous fluid therapy, positioning the mother to lie on her side to the left side, giving oxygenation and antibiotics as cyst eradicators causing infection. [24] In the case of fever in pregnant women, reducing body temperature immediately is the best thing to accelerate improvement in fetal well-being. [18] By creating a lower fetal ambient temperature, the fetal body heat easily expands around the fetus's dwelling.
Research on fetal distress due to fever, FHR can return to normal after maternal body temperature is obtained by administration of paracetamol 1000 mg / oral and in cases of fetal distress due to fever due to chorioamnionitis, after using a single dose 650 mg FHR acetaminophen suppository. Paracetamol is considered for pregnant women [25] and can reduce the temperature within 30-60 minutes, [26] but the function of paracetamol can only affect core temperature.
To reduce the surface temperature of the skin, it can be done by compressing warm water (WWC). The effectiveness of warm air compresses has been tested, as in permatasari studies, with the agreement of WWC 20 minutes can reduce body temperature to 1.2°C, more effective than ordinary air compresses. While in Hartatik's study, body temperature could drop 1.3°C. This reinforces the opinion that every 1 gram of warm air that evaporates, can release 0.58 kilo calories of body heat.[27,28] WWC on the abdominal wall is more effective than axillary[29] and can be done in children and adults.[30] WWC which is done on the abdominal wall, a favorable location for decreasing body temperature and decreasing body temperature closest to the fetus. With intra-uterine resuscitation interventions and handling of maternal infections combined with WWC, it can restore the kejanin blood supply and reduce the temperature around the fetus's residence so that the FHR can return to normal.
The type of this research was
The intervention was given in the form of a combination medical therapy peracetamol tablet 500 mg/oral single dose combined with Warm Water Compressive (WWC) 34-37 °C intervention, to pregnant women with infectious fever lying in the left side oblique position (15°), oxygenated a maximum of 4 liters and get intravenous fluid therapy (RL) of no more than 500 ml and the research process is carried out at room temperature with a temperature of 23-28 °C. The treatment control group was as the intervention group, but was not given intervention WWC 34- 37°C. Performed on 26 respondents divided into 1 research group, pregnant women with gestational age more than 22-40 weeks with fever infection temperature 37.5 °C in the hospital.
The intervention group received one time repeated dose of paracetamol 500mg /oral tablets and WWC. One time the compress period stretches the compress cloth on the surface of the abdominal wall and the entire surface of the lower back for 2 minutes, lift the cloth and let it dry. Repeat the compress stage until the treatment time is 60 minutes. Immediately treat the treatment after the first assessment. The duration of treatment is 60 minutes, the assessment is carried out every 10 minutes (1 pre, 6 post) for 60 minutes of treatment time. Measurements of the effect of treatment were carried out by assessing body temperature and FHR frequency. Fever that is included in the exclusion criteria is caused by drugs, critical illness and emergency due to bleeding.
Effect of Combination of Medical Therapy on Paracetamol and Intervention of Warm Water Compress on Mother's Body Temperature and Abnormal FHR Repair in Pregnant Women With Infection Fever.
Analysis of Prerequisites.
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| 0 | 0,012 | 0,206 | 0,111 | 0,031 |
| 10 | 0,015 | 0,211 | 0,207 | 0,159 |
| 20 | 0,015 | 0,227 | 0,047 | 0,024 |
| 30 | 0,031 | 0,129 | 0,525 | 0,028 |
| 40 | 0,674 | 0,033 | 0,074 | 0,118 |
| 50 | 0,692 | 0,151 | 0,117 | 0,087 |
| 60 | 0,901 | 0,056 | 0,308 | 0,000 |
Most of the data were normally distributed so that the statistical test used to test the hypothesis of differences in maternal body temperature and FHR frequency before and after treatment in each group was with
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| Age | ||||||
| < 20 years | 2 | 15,4 | 1 | 7,7 | 11,5 | |
| 20 – 35 years | 8 | 61,5 | 10 | 76,9 | 69,2 | 0,408* |
| > 35 years | 3 | 23,1 | 2 | 14,5 | 19,2 | |
| Total | 13 | 100 | 13 | 100 | 100 | |
| Number of pregnancies | ||||||
| Primigravida | 4 | 30,8 | 6 | 46,2 | 38,5 | |
| Multigravida | 8 | 61,5 | 4 | 30,8 | 46,2 | 0,109* |
| Grande multigravida | 1 | 7,7 | 3 | 23,1 | 15,4 | |
| Total | 13 | 100 | 13 | 100 | 100 | |
| Gestational age | ||||||
| Trimester II (12-27 week) | 6 | 46,2 | 4 | 30,8 | 38,5 | 0,188* |
| Trimester III (28-41 week) | 7 | 53,8 | 9 | 69,2 | 61,5 | |
| TotalDisease | 13 | 100 | 100 | 100 | 100 | |
| Midwifery | 10 | 76,9 | 9 | 69,2 | 73,1 | 0,402* |
| Non- Midwifery | 3 | 23,1 | 4 | 30,8 | 26,9 | |
| Total | 13 | 100 | 13 | 100 | 100 | |
The characteristics of the mother's age were mostly in the age range of 20-35 years (18 people), multigravida (12 people) and the highest gestational age was the third trimester of pregnancy due to fever due to midwifery infection 19 people (73.1%). From the Levene variant test, the characteristics of the data distribution are equivalent or homogeneous with a value of p> 0.05 so that they do not affect the results of the study.
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| Mother's Body Temperature (pre) | 38,34 ± 0,37 | 38,28 ± 0,43 | 0.299 |
| Frekuensi FHR (pre) | 174 ± 7,07 | 173 ± 8,07 | 0.741 |
The description of the mother's body temperature and FHR frequency at minute 0 (pre test) / before being given treatment, homogeneous data distribution. The body temperature before treatment in the intervention group averaged mean 38.34 °C (SD +0.37) and the average initial temperature of the control group respondents mean 38,28 °C (SD +0.43) with the second crew difference value group p = 0.299. The initial average frequency of FHR in the intervention group was 174 x /minute (SD +7.07) and the control group with an initial FHR rate of 173x /minute (SD +8.67). The difference in initial FHR frequency between groups as much as 1x pulse /minute was higher in the intervention group with a difference value of p = 0.741.
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| 0 | 38,34+ 0,373 | 0,012 | 38,28+ 0,430 | 0,206 |
| 10 | 38,23+ 0,307 | 0,015 | 38,25+ 0,369 | 0,211 |
| 20 | 38,06+ 0,323 | 0,015 | 38,12+ 0,352 | 0,227 |
| 30 | 37,87+ 0,293 | 0,031 | 38,03+ 0,307 | 0,129 |
| 40 | 37,65+ 0,263 | 0,674 | 37,86+ 0,250 | 0,033 |
| 50 | 37,34+ 0,369 | 0,692 | 37,65+ 0,233 | 0,151 |
| 60 | 37,01+ 0,382 | 0,901 | 37,36+ 0,243 | 0,056 |
Decreasing body temperature occurs gradually in both groups. The number of decreases in temperature in the intervention group: 0.11 °C, 0.17 °C, 0.19 °C, 0.22°C, 0.31 °C and 0.33 °C. The amount of the pre- body temperature drop to the 6 th measurement decreased by 1.33°C. In the control group: 0.03 °C, 0.13°C, 0.09 °C, 0.17 °C, 0.21 °C and finally 0.29 °C. Decreasing body temperature to post decreased by 0.92°C.
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| 0 | 174+ 7,07 | 0,111 | 173+ 8,07 | 0,031 |
| 10 | 173+ 6,60 | 0,207 | 172+ 7,73 | 0,159 |
| 20 | 172+ 6,47 | 0,047 | 171+ 7,47 | 0,024 |
| 30 | 168+ 4,55 | 0,525 | 169+ 7,10 | 0,028 |
| 40 | 165+ 3,59 | 0,074 | 166+ 5,55 | 0,118 |
| 50 | 160+ 2,28 | 0,117 | 163+ 4,45 | 0,087 |
| 60 | 158+ 1,96 | 0,308 | 160+ 03,57 | 0,000 |
From pre to each post assessment (after the intervention is given) the frequency of reduction in the intervention group can be described: 1 pulse, 1 pulse, 4 pulses, 8 pulses, and 2 pulses. the repair control group for 6 times the depicted rating decreases: 1 pulse, 1 pulse, 2 pulses, 3 pulses, 3 pulses, and 3 pulses at the 6th rating. The decrease in the frequency of FHR pre-to the post intervention group could decrease by 16x beats /minute, from 174x /minute (SD +7.07) to 158x /minute (SD +1.96). The FHR frequency control group dropped from 173x /minute (SD +8.07) to 160x /minute (SD +03.57), with a decrease of 13 beats per minute.
The highest number of subjects in the intervention group reached normal temperatures at the 40th minute measurement (8 people / 61.5%) and at the 60th minute had 100% normal labeling. In the control group, the highest number of subjects became normal temperatures in the 50th minute (5 people (38.5%). The difference in the number of subjects reached the normal temperature of the two groups, occurred in the 40th minute in the intervention group, and in the 50th minute in the control group. a difference of 10 minutes but with the weight of the number of intervention groups, more.
In the intervention group the subjects had reached a normal FHR frequency since the 30th minute. The number of subjects reached a normal FHR of 38.5% in the 50th minute. In the control group, the first control group experienced improvement in the normal FHR frequency, in the 50th minute (1 person) and the most in the 60th minute (76.9%) and could not reach 100% normal at 60 minutes.
Analysis of differences in body temperature between groups.
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| Suhu Badan | 1.046 | 1 | 1.046 | 1.660 | 0.210 |
The difference in maternal body temperature between the control group and the intervention group with a value of p> 0.05 (SD 1), which means there is no significant difference, mean square 1.046
Analyze body temperature differences in each group.
Control 37,86 + 0,250
Control37,36 + 0,243
The body temperature of the control group was higher than the intervention group. there was no difference in body temperature between groups but more intervention groups reached since the 10th minute measurement had reached a better temperature reduction than the control group. On measurements to 4-67 the second body temperature difference between groups: 0.33 °C, 0.21 °C, 0.32 °C, 0.035 °C.
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Minute to 60 | 1.331 | 0.000 |
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Minute to 60 | 0.915 | 0.000 |
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Minute to 10 | 1.108 | 0.059 |
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Minute to 10 | 0.023 | 1.000 |
| Minute to 10 | Minute to 20 | 0.169 | 0.000 | Minute to 10 | Minute to 20 | 0.131 | 0.000 |
| Minute to 20 | Minute to 30 | 0.192 | 0.000 | Minute to 20 | Minute to 30 | 0.92 | 0.239 |
| Minute to 30 | Minute to 40 | 0.223 | 0.000 | Minute to 30 | Minute to 40 | 0.169 | 0.001 |
| Minute to 40 | Minute to 50 | 0.308 | 0.17 | Minute to 40 | Minute to 50 | 0.215 | 0.000 |
Minute to 50Minute to 600.3310.000 Minute to 50 Minute to 600.2850.000
The intervention group before being given an average treatment of 38.34°C, and after being given treatment, became 37.01°C with a
In the Intervention group, body temperature since the first 10 minutes has decreased. The normal temperature was mostly achieved in the 50th minute, while in the new control group it was reached in the 60th minute. The difference in temperature reduction was not significant between the intervention group and the control group (p = 0.210).
The test results of the analysis of differences in FHR frequency between groups.
Frekuensi FHR31.736131.7360.1650.688
The mean squer of FHR frequency between groups was 31,736 (Df 1) and p = 0,688 (p> 0,05), which meant that there were no significant differences between groups.
Control173,00 + 8,07
Control172,31 + 7,73
Control170,92 + 7,47
Control169,23 + 7,10
Control 166,46 + 5,55
Control163,46 + 4,45
The difference in the difference in FHR frequency between groups, the difference in the difference in the control group was higher than the intervention group. The difference is at most 3 times the pulse in the 5th minute measurement. The intervention group can decrease to 16x beats / minute, from 174x / minute (SD +7.07) to 158x / minute (SD +1.96). In the control group the frequency of FHR dropped from 173x / minute (SD +8.07) to 160x / minute (SD +03.57), with a decrease of 13 beats / minute.
Intervals of measurementMean
Perbedaan
Perbedaan
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Minutes to 60 | 16.000 | 0.000 |
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Minutes to 60 | 13.385 | 0.000 | |
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Minutes to 10 | 0.308 | 1.000 |
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Minutes to 10 | 0.692 | 1.000 | |
| Minutes to 10 | Minutes to 20 | 1.769 | 0.005 | Minutes to 10 | Minutes to 20 | 1.385 | 0.158 | |
| Minutes to 20 | Minutes to 30 | 3.923 | 0.006 | Minutes to 20 | Minutes to 30 | 1.692 | 0.012 | |
| Minutes to 30 | Minutes to 40 | 3.077 | 0.000 | Minutes to 30 | Minutes to 40 | 2.769 | 0.048 | |
| Minutes to 40 | Minutes to 50 | 4.692 | 0.000 | Minutes to 40 | Minutes to 50 | 3.000 | 0.009 | |
| Minutes to 50 | Minutes to 60 | 2.231 | 0.042 | Minutes to 50 | Minutes to 60 | 3.846 | 0.006 |
Fetal heart rate
Measurement
In the intervention group, the effect of the treatment given to FHR between the pre test to the first measurement has not yet decreased p = 0.158. DJJ experienced improvements occurring from the 20th minute onwards. In the intervention group, the normal value of FHR was reached in the 50th minute, while in the new control group it was reached in the 60th minute.
Age of pregnant women with infectious fever in the age range of 21-35 years, pregnant women with many ages, trimester of pregnancy 16 people from 26 respondents (69.2%). many consider pregnancy disease (73.07%). The results of this study are supported by the results of a study of 31 of the 103 pregnant women studied 99.2% of fever infections and 19.4% of these increased tachycardia. Rupture of the bag increases the reserve of infection during pregnancy pregnant women improve fever. So with the largest number of respondents with midwifery infections,[8,11,14] supporting the theory of microorganisms reaching the amniotic cavity and fetus, so that the highest number of respondents is due to fever infection.
The decrease in body temperature of both groups reached normal occurred at the same time in the 30th minute but the number of intervention groups was more. The intervention group 10 minutes earlier experienced a decrease in body temperature compared to the control group. This illustrates that the combination of WWC and paracetamol is better than only with paracetamol alone. paracetamol can affect core temperature.[32] The use of paracetamol in pregnant and nonpregnant mothers has the same effectiveness.[33] So that in the control group, body temperature became normal at the time of the last assessment because only medical therapy for paracetamol tablets 500 mg was given.
Expansion of the FHR frequency during the 60 minute research process, the average improvement in the frequency of FHR can return to normal first time in the intervention group. Occurs in the 3rd assessment after the treatment was started and achieved improvement to normal at the 5th assessment of 5 people (38.5%). Whereas in the control group, the first time the FHR frequency became normal in the 50th minute amounted to 1 person and the most in the 60th minute amounted to 10 people (76.9%) and there were 2 respondents who had not experienced improvement after the treatment was completed. the intervention group experienced better improvement than the control group. With a decrease in body temperature, it will affect the uteroplacental blood flow system.[10] So that after the temperature decreases, blood flow to the fetus becomes smooth again and affects the repair of FHR.[34]
In the intervention group the initial temperature was 38.34 °C and reached an average of 37.01 °C (up to 0.387) in the 60th minute, with a decrease in the amount of body temperature of approximately 1.3 °C. While in the control group who gave 500 mg/ oral paracetamol tablets and 3 other fetal distress treatments, until the end of the 60th minute the initial temperature treatment was 38.28 °C and the body temperature decreased 0.9 °C to 37.36 °C (to 0.243 ) The difference in the degree of decline of the two groups is 0.3 °C. Both groups experienced a gradual decline with an analysis test to calculate the difference using
The description of the time of temperature drop between groups began to occur in the 40th minute until the 60th minute of the two groups. the earlier intervention group reached an average of normal temperature in the 50th minute while in the control group it occurred in the 60th minute. The two groups differed by 10 minutes to decrease the body temperature of the fever. ANOVA repeat test analysis results (Test of Between Subject Effect) between groups showed the results of p> 0.05, which means there was no significant difference between the FHR frequency between groups on each measurement.
The results of this study are in line with Permatasari's research, that WWC is more effective than if it reduces the body temperature of external techniques using ordinary water. [35] Although the study did not use paracetamol. While in the Mahdiyah study, et al., [27] strongly supported this study, the temperature declined faster by giving a combination of paracetamol with a WWC combination. The results of the muthalib study strongly support this study, where WWC on the abdominal wall is more effective considering the compressed surface area that supports more evaporation processes [30] and WWC carried out in adults as in the Widiasih study, supporting this study.[30] However, the results of the Maya case study , not in line with this study, WWC on the abdominal wall is no more effective than WWC in the axilla.[36]
A decrease in temperature of 1.33 in the combination group of paracetamol and WWC from the results of this study, with the support of giving intravenous fluids, at room temperature 23-28 °C, the mother's body temperature can reach normal temperatures 10 minutes earlier than the control group.
After being given treatment for 60 minutes, in both groups the improvement of FHR frequency was gradual, 16 beats/ minute, from 173.44x/ minute to 157.77x/ minute in the intervention group and decreased 13x beats/ minute from 173x/ minute to 159.62x/ minute in the control group. The difference in the decrease in body temperature of both groups from the results of the analysis of Repeated Measure Anova (Test of Between Subject Effect) shows the value of p = 0.688 (p> 0.05), meaning that there is no significant difference. However, clinically, the combination-intervention group showed more rapid decreases of 20 minutes earlier reaching normal and with the most normal FHR on the 50th minute, with 100 respondents reaching the normal limit.
Whereas in the control group, the decrease in FHR was 3 times the rate with the control group with the average decline occurring in the 60th minute with 2 respondents not yet achieving normal values at the 7th assessment (60th minute after treatment). The time difference in the average of achieving a normal difference of 10 minutes first reached normal in the intervention group. With a decrease in the mother's body temperature, it will be followed by repair of FHR,[37,38] and lying on her side to the left side, with a slope of 15, can contribute to the improvement of FHR frequency,[39] and fetal oxygenation can improve FHR if it is not caused by a blocked blood flow. [40]
The act of accelerating the decrease in body temperature from the inside by using medical therapy paracetamol whose mechanism of action can reduce core temperature[41] and by using WWC intervention on the stomach wall of pregnant women with fever, besides being able to reduce surface body temperature, and cool the temperature around the fetus's residence. So that the higher fetal temperature due to increased maternal temperature and the process of infection can be transferred around the fetus of the abdominal wall. To see the correlation between the effect of decreasing the temperature of the skin surface of the abdominal wall and the improvement of FHR frequency after the temperature has decreased, it still needs further research.
From the results of this study, the combined group of paracetamol and WWC medical therapies could reduce body temperature more and improve abnormal FHR frequency even though the differences between the two groups were not significant, lowering the average body temperature level and faster body temperature reduction than the control group. The intervention group, lowering the average FHR frequency and earlier 20 minutes can achieve improvement in the frequency of FHR to normal.
It is hoped that it can be used as an input material in developing clinical procedures to improve the quality of care for pregnant women with fever.
In clinical application, this WWC intervention can be carried out by patients and families at home if there is a fever in pregnant women to create a lower ambient temperature than the mother's temperature before receiving doctor therapy. With WWC in the abdominal area, starting from the lower part of the mother's breast to the lower abdomen (the area where the fetus lives in the abdominal cavity), use a small towel soaked in warm water then squeeze and cover the entire abdomen and lower back (back of the stomach area) for 1-2 minutes. Then left until the water on the surface of the stomach and lower back evaporates.
Can contribute to the development of midwifery and nursing theories in high-temperature management due to fever infections in pregnant women.
Suggestions for subsequent research, limiting the types of causes of infectious fever, comparing core temperatures and surface temperatures, changing different types of water, involving labor fever, and increasing the allocation of time for research.
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