Infective endocarditis is rare in pregnancy but threatens the life of both mother and child. Fatal cases of endocarditis in pregnancy have occurred antenatally, rather than as a consequence of infection acquired at the time of delivery . Treatment is essentially the same as outside pregnancy
Table 26.1 Stratification of cardiac conditions according to risk of bacterial endocarditis
High-risk Prosthetic valves (metal, bioprosthetic and homografts) Endocarditis Previous bacterial endocarditis, Complex prophylaxis cyanotic congenital heart disease recommended (Fallot's, Transposition of great arteries)
Surgical systemic/pulmonary shunt Moderate-risk Other congenital cardiac malformations,
Surgically repaired ASD, VSD, PDA Endocarditis Mitral valve prolapse without prophylaxis not regurgitation, Physiological heart recommended murmurs, Cardiac pacemakers
Adapted from .
with emergency valve replacement if indicated. As always, the baby should be delivered if viable before the maternal operation.
Antibiotic prophylaxis is mandatory for those with prosthetic valves and for those with a previous episode of endocarditis . Many cardiologists recommend that women with structural heart defects (e.g. VSD) also receive prophylaxis. Recommendations of the American Heart Association stratify cardiac conditions into high-, moderate- and negligible (not requiring antibiotic prophylaxis) risk  (Table 26.1).
The current UK recommendations (24) are amoxycillin 2 g i.v. plus gentamicin 120 mg i.v. at the onset of labour or ruptured membranes or prior to Caesarean section, followed by amoxycillin 500 mg orally (or i.m/i.v. depending on patient's condition) 6 h later.
For women who are allergic to penicillin, vancomycin 1 g i.v. or teicoplanin 400 mg i.v. may be used instead of amoxycillin .
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