Infective endocarditis in obstetric and gynecologic practice.

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Cardiology

Background:

• Infective endocarditis is an uncommon complication in obstetric and gynecologic practice.
• Historically, over 124 cases have been reported in English and selected European literature within the last 40 years.

Purpose of the Study:

• To evaluate the incidence, causative agents, mortality rates, and necessity of antibiotic prophylaxis for infective endocarditis in obstetric and gynecologic patients.
• To provide guidance on antibiotic prophylaxis for infective endocarditis in specific obstetric and gynecologic scenarios.

Main Methods:

• Literature review of reported cases of infective endocarditis in obstetric and gynecologic practice over the past 40 years.
• Analysis of causative microorganisms, mortality rates (maternal and fetal), and trends in incidence.
• Assessment of the risk-benefit ratio for routine endocarditis prophylaxis.

Main Results:

• Streptococci, particularly viridans streptococci, were the predominant causative agents (74%).
• Overall mortality rate was 29%, with a 23% fetal mortality rate.
• The incidence of endocarditis in this setting is low and appears to be decreasing.

Conclusions:

• Routine antibiotic prophylaxis for infective endocarditis is not favored for most common obstetric and gynecologic procedures.
• Prophylaxis should be considered for high-risk patients with underlying heart conditions undergoing specific procedures.
• Recommended regimens include parenteral ampicillin plus gentamicin or vancomycin plus gentamicin for highest risk, and oral amoxicillin for lower-risk situations.