Fatal meningitis during pregnancy in the Netherlands: a nationwide confidential enquiry
Article first published online: 24 AUG 2012
© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 119, Issue 13, pages 1558–1563, December 2012
How to Cite
Schaap, T., Schutte, J., Zwart, J., Schuitemaker, N., van Roosmalen, J. and on behalf of the Dutch Maternal Mortality Committee (2012), Fatal meningitis during pregnancy in the Netherlands: a nationwide confidential enquiry. BJOG: An International Journal of Obstetrics & Gynaecology, 119: 1558–1563. doi: 10.1111/j.1471-0528.2012.03443.x
- Issue published online: 12 NOV 2012
- Article first published online: 24 AUG 2012
- Accepted 26 April 2012. Published Online 24 August 2012.
- Ear infection;
- maternal mortality;
- otolaryngological infection;
Please cite this paper as: Schaap T, Schutte J, Zwart J, Schuitemaker N, van Roosmalen J. Fatal meningitis during pregnancy in the Netherlands: a nationwide confidential enquiry. BJOG 2012;119:1558–1563.
Objective To determine the incidence of maternal deaths attributable to meningitis in the Netherlands, and to assess clinical features and risk factors.
Design Confidential enquiry into the causes of maternal deaths.
Setting Nationwide in the Netherlands.
Population A total of 4 784 408 live births.
Methods Analysis of all maternal deaths due to meningitis in pregnancy and puerperium from 1983 up to and including 2007 reported to the Maternal Mortality Committee of the Dutch Society of Obstetrics and Gynaecology.
Main outcome measures Incidence, clinical features and risk factors.
Results Fifteen maternal deaths occurred due to meningitis, representing 4.4% of all maternal deaths. Twelve women (80%) presented with meningitis during pregnancy, 8 (66%) of them in the third trimester. Presenting symptoms were altered mental status (11; 73%), fever (9; 60%), nuchal rigidity (5; 33%) and headache (13; 87%). Nine women (60%) had otolaryngological infection at presentation or in the previous days or weeks. Twelve women (80%) underwent radiological examination, of which 5 (33%) showed distinct abnormalities. Cerebrospinal fluid (CSF) examination showed infected CSF in 8 (53%) women. In ten women (67%) Streptococcus pneumoniae was isolated. Substandard care was identified in 4 (27%) women.
Conclusion Pregnant or puerperal women presenting with classical symptoms of meningitis, particularly those with a history of otolaryngological infection or headache, should undergo thorough investigation and radiological and CSF examinations. Early diagnosis and immediate antibiotic treatment are imperative because of rapid deterioration in pregnant women. In case of doubt, the threshold for antibiotic treatment should be low and close monitoring is warranted.