title: Fatal meningitis during pregnancy in the Netherlands: a nationwide confidential enquiry.
abstract: OBJECTIVE
  To determine the incidence of maternal deaths attributable to meningitis in the Netherlands, and to assess clinical features and risk factors.
  
  
  METHODS
  Confidential enquiry into the causes of maternal deaths.
  
  
  METHODS
  Nationwide in the Netherlands.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, the Netherlands. tpschaap@gmail.com
authors.forename: T P
authors.initials: TP
authors.lastname: Schaap
authors.forename: J M
authors.initials: JM
authors.lastname: Schutte
authors.forename: J J
authors.initials: JJ
authors.lastname: Zwart
authors.forename: N W E
authors.initials: NW
authors.lastname: Schuitemaker
authors.forename: J
authors.initials: J
authors.lastname: van Roosmalen
mesh_terms: D000208:Acute Disease; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008428:Maternal Mortality; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D008586:Meningitis, Pneumococcal / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D011645:Puerperal Infection / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors