Saving Mothers' Lives: - Public Health Agency for Northern Ireland

Previous Reports have emphasised that women with epilepsy should have specialist care in pregnancy
from a consultant obstetrician and a neurologist or specialist physician with interest in epilepsy and
pregnancy. All members of the health care team both those directly concerned with pregnancy and
specialists in other disciplines such as neurology, must ensure that women with life threatening conditions
such as epilepsy are seen as early in pregnancy as possible.
Miscellaneous central nervous system disease
Two women died from acute hydrocephalus due to cysts in the midbrain. In one case:
A woman started to complain of new onset, persistent and severe headaches in mid pregnancy.
No underlying obstetric cause was found and there was no record of a full neurological
examination which should have included visualisation of her optic fundi. She had several
admissions with headache, dizziness and visual disturbance but no abnormality was found
and she was sent home. Eventually she developed unsteady gait and nystagmus, and rapidly
deteriorated. She died after a CT scan at another hospital several miles away showed a cystic
lesion in her midbrain.
New onset headache is quite common in pregnancy and is usually benign. But this woman’s headache
seems to have been much more severe than most and should have been investigated further. As maternity
services continue to reconfi gure, consultant led maternity units should have on-site access to modern
imaging facilities such as CT and MRI scans.
Infectious diseases
Bacterial infection
Five women died from bacterial meningitis. Two deaths were attributed to pneumoccocal meningitis, one
to purulent meningitis where the organism was not found and two to tuberculous meningitis. Disseminated
tuberculosis also caused one death and there was a further Late death reported that was attributed to
tuberculous meningitis.
Tuberculous meningitis
Both the cases of tuberculous meningitis in pregnancy were diagnosed late, as often happens, and both
occurred in women whose families were from the Asian sub-continent. In one case the diagnosis was
delayed as the husband was acting as the interpreter, a recurrent feature of several deaths from a variety
of causes in this and in previous Reports. There is still a great need for funding to be made available for
suitably trained interpreters both in the community and in hospitals. The other case gave particular cause
for concern:
A multigravid woman fi rst complained of musculoskeletal pain in mid pregnancy for which her GP
referred to her to an orthopaedic surgeon, who found nothing. She also attended the Emergency
Department (ED) on a number of occasions. When she fi nally saw her obstetric consultant, by
now also complaining of headache, she was referred for investigation to a tuberculosis clinic.
Before she could be seen she was admitted via the ED to a medical ward with possible pulmonary
tuberculosis. This admission, some weeks after her initial complaint of musculoskeletal pain, was
precipitated by a few days history of fever and night sweats. Shortly after admission she became
confused and a lumber puncture confi rmed meningitis. She then went into labour, undetected,
and had a live baby before the midwives were called. Subsequently she also had a postpartum
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