Outcome of Pregnancy Complicated by Infective Endocarditis: A Review of Published Literature over Past Three Decades

Abstract

Background - Infective endocarditis (IE) is a rare complication during pregnancy but it associates with high maternal and foetal mortality. Our aim was to study maternal and foetal outcomes in published cases of IE during pregnancy. Method - A PubMed literature survey was done using "pregnant" "pregnancy" and "endocarditis" as the key words. All case reports published between 1981 and 2010 in English language were reviewed to study patient demography, causative organisms, pre disposing factors, methods of treatment and clinical outcomes. Results - A total of 41 case reports (43 pregnant women with IE) were reviewed. Mean age was 28 (±4.75) years. IE was diagnosed in their first, second and third trimesters in 5%, 31%, and 43% respectively while 21% of the cases were diagnosed during postnatal period. Prior history of valve disease was known in 30%. Commonest causative organisms were Streptococcus (51%) and Staphylococcus (29%) species. Mitral, aortic, tricuspid valves were involved in 53%, 33% and 25% cases respectively. Valve replacement surgery was done in 50% patients (18% before delivery). Maternal mortality was 9.30%. Foetal mortality was 7% (all were due to abortions). Maternal complication rate was 79% [most common complications included thromboembolism in 21%, septic embolism in 23%, cardiac failure in 21%, obstetric complications in 16% and nosocomial infections in 7%]. Conclusion - Pregnancy complicated by IE is associated with significant morbidity and mortality for both mother and foetus. Extreme care is necessary for pregnant women who were diagnosed with IE and should be managed in a tertiary centre with multidisciplinary specialist care.