Antipyretic Treatment for Intrapartum Fever: Dipyrone vs Acetaminophen (RCT)

Chorioamnionitis, or intraamniotic infection, affects 2-5% of term deliveries and is associated with significant maternal and neonatal risks, including a 3- to 4-fold increase in cesarean delivery. Management includes prompt antibiotic treatment and antipyretic use, particularly during labor, where maternal fever may contribute to fetal acidosis and increased risk of neonatal encephalopathy. Even in the absence of acidosis, maternal fever alone is linked to adverse neonatal outcomes. Antipyretics may also help resolve fetal tachycardia, potentially avoiding unnecessary cesarean sections. While both dipyrone and acetaminophen are considered safe, it remains unclear which has superior efficacy in the intrapartum setting, and an agent with faster onset may offer clinical advantages.

Stages of study: Following the diagnosis of suspected intrapartum intraamniotic infection, eligible women will be offered to participate. All women will be treated with the same broad-spectrum antibiotic regimen. As stated above, those who gave their informed consent will be randomly assigned to either dipyrone or acetaminophen.

After administering antipyretic treatment, oral temperature will be monitored every 5 minutes for up to 40 minutes.

Inclusion criteria

• Women undergoing a trial of vaginal delivery, with suspected intra-amniotic infection defined as isolated maternal fever of 39°C or greater, or an sustained oral temperature of 38-38.9°C for at least 30 minutes or with one or more of the following: maternal leukocytosis, purulent cervical drainage, or fetal tachycardia.

Exclusion criteria

• Known history of adverse events for dipyrone or acetaminophen
• Age <18 years
• Gestational age <24 weeks
• Intrauterine fetal death
• Fever onset prior to delivery
• Known liver disease
• Known leukopenia
• In addition, those who will develop allergic event or any adverse event possible related to any of the antipyretics used will be excluded from the