Clinical features and maternal and infant outcomes of right-sided infective endocarditis during pregnancy: a case report and literature review
10.3760/cma.j.issn.1007-9408.2020.01.006
- VernacularTitle: 妊娠合并右心感染性心内膜炎的临床特征及母婴结局的文献分析
- Author:
Fengcheng ZHAO
1
;
Gang QIN
2
;
Qingdan YUAN
1
Author Information
1. First Clinical Medical College of Shanxi Medical University, Taiyuan 030001, China
2. Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan 030001, China
- Publication Type:Clinical Trail
- Keywords:
Pregnancy complications, cardiovascular;
Endocarditis, bacterial;
Pregnancy outcome
- From:
Chinese Journal of Perinatal Medicine
2020;23(1):29-34
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical features, treatment strategies, and maternal and infant outcomes of pregnancy complicated by right-sided infective endocarditis (RSIE) to provide evidence for clinical management.
Methods:By searching literature on RSIE during pregnancy from the databases of CNKI, Wanfang Database, VIP, CBM, PubMed, OVID, EMbase and ScienceDirect, relevant information were collected to analyze the clinical manifestations, risk factors, positions of intracardiac vegetations, results of blood culture, treatment strategies and maternal and infant outcomes of RSIE.
Results:A total of 15 articles were retrieved, involving 18 infected gravidas with the average age of (27.7±4.8) years and average gestational age at onset of (27.8±6.9) weeks. Fever (n=14), cough (n=12), anemia (n=8) and shortness of breath or dyspnea (n=8) were the common symptoms. Cardiac murmurs were detected on auscultation in seven cases, of which six were systolic murmurs and one was unspecified. Heart sounds of five cases were clear on auscultation without any murmurs. Nine cases were complicated by pulmonary embolism and five by heart failure. The major risk factors were congenital heart diseases (10/18) and intravenous drug abuse (6/18). Vegetations were commonly seen on the tricuspid valves (10/18), followed by the pulmonary valves (4/18). The rate of positive blood culture was high (15/16) with Staphylococcus (9/15) and Streptococcus (3/15) being the primary pathogens. Most pregnancies were timely ended by cesarean section. Apart from receiving fundamental antibiotic therapy for infective endocarditis, 11 patients underwent cardiac surgery, including vegetation removal, valve repair or replacement and surgery for congenital heart diseases, before or after pregnancy or during cesarean section based on their gestational age, condition, and cardiopulmonary function. There was no maternal death, but one neonatal death was reported due to severe asphyxia following cesarean section at 28 weeks. Maternal and neonatal outcomes were good during follow-up.
Conclusions:Pregnancy complicated by RSIE is rare and complex, requiring early diagnosis and individualized treatment. Adequate and full-course antibiotic therapy, appropriate surgical procedures and timely termination are of great importance for improving maternal and infant outcomes.
