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Fatal meningitis during pregnancy in the Netherlands: a nationwide confidential enquiry.
- Source :
-
BJOG : an international journal of obstetrics and gynaecology [BJOG] 2012 Dec; Vol. 119 (13), pp. 1558-63. Date of Electronic Publication: 2012 Aug 24. - Publication Year :
- 2012
-
Abstract
- Objective: To determine the incidence of maternal deaths attributable to meningitis in the Netherlands, and to assess clinical features and risk factors.<br />Design: Confidential enquiry into the causes of maternal deaths.<br />Setting: Nationwide in the Netherlands.<br />Population: A total of 4 784 408 live births.<br />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.<br />Main Outcome Measures: Incidence, clinical features and risk factors.<br />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.<br />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.<br /> (© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.)
- Subjects :
- Acute Disease
Adult
Cross-Sectional Studies
Female
Humans
Incidence
Maternal Mortality
Meningitis, Bacterial diagnosis
Meningitis, Bacterial etiology
Meningitis, Pneumococcal diagnosis
Meningitis, Pneumococcal etiology
Meningitis, Pneumococcal mortality
Netherlands epidemiology
Pregnancy
Pregnancy Complications, Infectious diagnosis
Pregnancy Complications, Infectious etiology
Puerperal Infection diagnosis
Puerperal Infection etiology
Puerperal Infection mortality
Retrospective Studies
Risk Factors
Meningitis, Bacterial mortality
Pregnancy Complications, Infectious mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1471-0528
- Volume :
- 119
- Issue :
- 13
- Database :
- MEDLINE
- Journal :
- BJOG : an international journal of obstetrics and gynaecology
- Publication Type :
- Academic Journal
- Accession number :
- 22925078
- Full Text :
- https://doi.org/10.1111/j.1471-0528.2012.03443.x