Fatal meningitis during pregnancy in the Netherlands: a nationwide confidential enquiry

• Published in: BJOG : an international journal of obstetrics and gynaecology 2012-12, Vol.119 (13), p.1558-1563
• Main Authors: Schaap, TP, Schutte, JM, Zwart, JJ, Schuitemaker, NWE, van Roosmalen, J
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Biological and medical sciences; Cross-Sectional Studies; Ear infection; encephalitis; encephalomeningitis; Female; Gynecology. Andrology. Obstetrics; Humans; Incidence; Maternal Mortality; Medical sciences; Meningitis; Meningitis, Bacterial - diagnosis; Meningitis, Bacterial - etiology; Meningitis, Bacterial - mortality; Meningitis, Pneumococcal - diagnosis; Meningitis, Pneumococcal - etiology; Meningitis, Pneumococcal - mortality; Mortality; Netherlands - epidemiology; otolaryngological infection; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - etiology; Pregnancy Complications, Infectious - mortality; pregnancy-related; Puerperal Infection - diagnosis; Puerperal Infection - etiology; Puerperal Infection - mortality; Retrospective Studies; Risk Factors; sinusitis
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2012.03443.x

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.