What is the management for a pregnant woman in her 3rd trimester exposed to someone with meningitis?

Management of Pregnant Women in Third Trimester Exposed to Meningitis

For pregnant women in their 3rd trimester who have been exposed to someone with meningococcal meningitis, a single dose of 250 mg ceftriaxone administered intramuscularly is the first-choice prophylactic treatment. 1

Antibiotic Prophylaxis for Meningococcal Exposure

Prophylactic antibiotic treatment is strongly recommended for all close contacts of patients with meningococcal meningitis to prevent secondary cases and eradicate meningococcal carriage 1. For pregnant women, the management differs based on the type of exposure:

• Close contact with meningococcal meningitis: Prophylactic antibiotics are required 1
• Close contacts are defined as:
  • Household members
  • Child care center contacts
  • Anyone directly exposed to oral secretions 1

Recommended Prophylactic Antibiotics for Pregnant Women in 3rd Trimester

• First choice: Ceftriaxone 250 mg intramuscular as a single dose 1
• Alternative (only after first trimester): Rifampicin 600 mg twice daily for 2 days 1
• Not recommended during pregnancy: Ciprofloxacin 1

Special Considerations for Pregnant Women

Pregnant women require special attention when exposed to meningitis due to potential risks to both mother and fetus:

• Bacterial meningitis during pregnancy can be rapidly fatal and is associated with fetal death, especially in the first trimester 2
• Streptococcus pneumoniae is the most commonly reported causative organism of bacterial meningitis during pregnancy 2
• An extended period between onset of maternal illness and delivery appears to reduce the risk of neonatal transmission 3

Management Based on Type of Meningitis

For Meningococcal Meningitis Exposure:

• Provide immediate antibiotic prophylaxis as outlined above 1
• Consider vaccination with meningococcal vaccine for ongoing protection if there is a community outbreak 1

For Pneumococcal Meningitis Exposure:

• Routine prophylaxis is not recommended for contacts of patients with pneumococcal meningitis 4
• Close monitoring for symptoms is advised instead 4

Monitoring After Exposure

• Monitor for signs and symptoms of meningitis including fever, headache, neck stiffness, altered mental status, and photophobia 3
• Any concerning symptoms should prompt immediate medical evaluation 2
• No special antepartum fetal monitoring is required solely based on potential exposure 1

Pitfalls and Caveats

• Timing matters: Prophylaxis should be administered as soon as possible after exposure is identified 1
• Don't use ciprofloxacin: Unlike in non-pregnant adults, ciprofloxacin is contraindicated during pregnancy 1
• Don't delay treatment: Bacterial meningitis during pregnancy can progress rapidly with devastating outcomes for both mother and fetus if treatment is delayed 3, 2
• Don't confuse management: Different pathogens causing meningitis require different prophylaxis approaches - ensure you know which organism is involved 4

Follow-up

• No special follow-up is required if the pregnant woman remains asymptomatic after receiving appropriate prophylaxis 1
• Educate the patient about symptoms that should prompt immediate medical attention 2