Infective Endocarditis in Pregnancy: A Contemporary Cohort

Malamo E. Countouris; Amy L. Marino; Megan Raymond; Alisse Hauspurg; Kathryn L. Berlacher

doi:10.1055/a-1877-5763

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2024; 41(S 01): e230-e235
DOI: 10.1055/a-1877-5763

Original Article

Infective Endocarditis in Pregnancy: A Contemporary Cohort

Authors

Malamo E. Countouris

¹University of Pittsburgh Medical Center, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
Amy L. Marino

¹University of Pittsburgh Medical Center, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
Megan Raymond

²Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Alisse Hauspurg

³Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Pittsburgh Medical Center University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Kathryn L. Berlacher

¹University of Pittsburgh Medical Center, Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania

Abstract

Objective Pregnancy-related infective endocarditis (IE) caries a high risk of morbidity and mortality. With increasing intravenous drug abuse (IVDA) amid the opioid epidemic, the risk factor profile may be shifting. In this case series, we aimed to describe risk factors and outcomes for peripartum IE in a contemporary cohort.

Study Design We identified patients with IE diagnosed during pregnancy or up to 6 weeks' postpartum from 2015 through 2018 at a single tertiary care center. We abstracted detailed medical history and clinical outcome measures from the electronic medical record. The diagnosis of IE was supported by the modified Duke Criteria.

Results Nine patients had peripartum IE: eight (89%) with a history of IVDA, one with an indwelling central venous catheter (11%), and one with prior IE (11%). None had preexisting congenital or valvular heart disease. Six (67%) had comorbid hepatitis C. Eight cases (89%) had gram-positive cocci with vegetations involving the tricuspid valve (56%) and both mitral and tricuspid valves (22%). Major complications included shock (33%), mechanical ventilation (44%), septic emboli (67%), and noncardiac abscesses (33%). Two patients underwent valve surgery, and there were two cases of postpartum maternal mortality (22%), one from septic shock and one from intracerebral hemorrhage. While four patients (44%) delivered preterm (average gestational age 35 weeks), most delivered vaginally (89%) with only one requiring an emergent caesarean section. There was no fetal mortality, although three newborns (43%) required admission to the neonatal intensive care unit. Two patients were initiated on medication-assisted treatment for opioid use disorder. Consultants included infectious disease, cardiology, cardiac surgery, maternal-fetal medicine, and psychiatry.

Conclusion These findings confirm that IVDA is a growing risk factor for pregnancy-related IE. Peripartum IE carries a high risk of complications, including maternal mortality, and warrants management with a multidisciplinary care team at a tertiary center.

Key Points

Intravenous drug use was the most common risk factor for IE in pregnancy.
IE in pregnancy carries a high morbidity and mortality with complications including septic emboli, septic shock, and need for mechanical ventilation.
A multidisciplinary team approach can assure the best possible maternal and fetal outcomes.

Keywords

infective endocarditis - valvular disease - pregnancy - peripartum - intravenous drug use - opioid use disorder

Volltext

Referenzen

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