Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, the Netherlands.
BJOG. 2012 Dec;119(13):1558-63. doi: 10.1111/j.1471-0528.2012.03443.x. Epub 2012 Aug 24.
To determine the incidence of maternal deaths attributable to meningitis in the Netherlands, and to assess clinical features and risk factors.
Confidential enquiry into the causes of maternal deaths.
Nationwide in the Netherlands.
A total of 4 784 408 live births.
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.
Incidence, clinical features and risk factors.
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.
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.
确定荷兰因脑膜炎导致的孕产妇死亡发生率，并评估其临床特征和危险因素。
对 1983 年至 2007 年期间荷兰全国性孕产妇死亡原因进行机密调查。
对荷兰妇产科协会孕产妇死亡率委员会报告的所有妊娠和产褥期因脑膜炎导致的孕产妇死亡进行分析。
荷兰全国。
共 4784408 例活产。
1983 年至 2007 年期间报告给荷兰妇产科协会孕产妇死亡率委员会的所有妊娠和产褥期因脑膜炎导致的孕产妇死亡。
发生率、临床特征和危险因素。
15 例孕产妇死于脑膜炎，占所有孕产妇死亡的 4.4%。12 例（80%）妇女在妊娠期间出现脑膜炎，其中 8 例（66%）在妊娠晚期。首发症状为精神状态改变（11 例；73%）、发热（9 例；60%）、颈项强直（5 例；33%）和头痛（13 例；87%）。9 例（60%）妇女在就诊时或之前几天或几周内有耳鼻喉感染。12 例（80%）妇女接受了影像学检查，其中 5 例（33%）显示明显异常。8 例（53%）妇女的脑脊液（CSF）检查显示有感染性 CSF。10 例（67%）妇女分离出肺炎链球菌。4 例（27%）妇女存在护理不当。
出现脑膜炎典型症状的妊娠或产褥期妇女，特别是有耳鼻喉感染或头痛史的妇女，应进行全面检查、影像学检查和 CSF 检查。由于孕妇病情迅速恶化，早期诊断和立即给予抗生素治疗至关重要。如有疑问，应及早给予抗生素治疗并密切监测。
