Mortality from Peripartum Meningitis

Abstract

A young primigravid parturient had an uneventful labour under epidural analgesia and delivered a healthy male infant. She returned 48 hours later with fever, vomiting and severe headache, but was misdiagnosed as having endometritis. Further signs of meningitis appeared six hours later, however she succumbed to the infection and died four weeks later despite intensive care and high-dose antibiotic management. Causes of meningitis in the peripartum period are discussed. The possibility of a causal association between the patient's epidural analgesia and her infection are considered and preventive measures discussed.

Infection as a complication of neuraxial blockade

“…Nevertheless, judging by the numbers of published cases, it could be the second commonest neurological complication of neuraxial analgesia in labour, after paraesthesiae. Loo et al 6 found 20 cases, 31,[43][44][45][46][47][48][49][50][51][52][53][54] while at least seven others [55][56][57][58][59][60][61] and one case of Herpes simplex encephalitis 62 among parturients, and dozens more among non-obstetric patients, have been reported since.…”

“…46 The outlook is generally good in the immunocompetent, although a death has been reported in an obstetric patient. 59 The causative organism, generally a viridans-type streptococcus of low virulence, lives harmlessly in the upper air passages and the vagina, but the cerebrospinal fluid provides it with a favourable culture medium. 13 In some cases, b-haemolytic Strep or Psuedomonas have been isolated, while in several instances no organisms have been grown, 31,44,51 and chemical contamination has been blamed.…”

“…31,50,52,55,59 Epidural analgesia is used more commonly than spinal in labour, but the numbers of case reports of meningitis following known dural puncture far outweigh the epidural cases. Is epidural analgesia purely coincidental then?…”

Progress in analgesia for labor: focus on neuraxial blocks

“…33 Headache and neck pain or neck stiffness in a patient who recently had spinal anesthesia is often attributed to PDPH. One case report 34 highlighted the danger associated with missed diagnosis. Her condition deteriorated, and meningitis was not considered as a diagnosis until it was too late and the patient subsequently died in an intensive care unit.…”