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Case Reports in Obstetrics and Gynecology
Volume 2014, Article ID 268693, 4 pages
http://dx.doi.org/10.1155/2014/268693
Case Report

Maternal and Fetal Death following Group A Streptococcal Meningitis in Mid-Term Pregnancy

1Imperial College School of Medicine, Imperial College London, London SW7 2AZ, UK
2The Devonshire Lodge Practice, 12A Abbotsbury Gardens, Eastcote, London HA5 1TG, UK
3King's College London, Strand Campus, London WC2R 2LS, UK
4The Hillingdon Hospital, Uxbridge, London UB8 3NN, UK

Received 17 February 2014; Accepted 11 March 2014; Published 4 May 2014

Academic Editor: Svein Rasmussen

Copyright © 2014 Sayinthen Vivekanantham et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Group A streptococcal (GAS) meningitis is rarely seen in the antenatal period, but it is associated with significant mortality. We present a case of a mid-trimester woman who developed fulminant meningitis following a rapid onset atypical presentation of infection with this organism. Case. A multiparous 23+5-week woman presented with a 10-day history of a non-productive cough associated with pyrexia. Within minutes of her admission she collapsed and lost consciousness; sepsis was suspected and cross-specialty care was initiated. She was managed empirically in extremis with broad-spectrum antibiotics and mannitol with 3% hypertonic saline for suspected infection and raised intracranial pressure, respectively. Despite intensivist management, a CT head revealed diffuse oedema with coning of the cerebellar tonsils. Brainstem death was certified within 19 hours of admission and fetal death ensued. Postmortem bacteriology confirmed GAS meningitis. Conclusion. Through raising awareness of this patient and her disease course, we hope that future policy decisions, primary care, and hospital level management will be informed accordingly for treatment of pregnant women with suspected GAS infection.