Goldman1*, Riga2, Huyong3, Van PouckH4, Guillaume1, Milas5 and Hollemaert1
1Department of Gynaecology, CHU Tivoli, Belgium
2Department of Cardiology, CHU Tivoli, Belgium
3Department of Cardiac Surgery, CHU Tivoli, Belgium
4Department of Neonatology, CHU Tivoli, Belgium
5Department of Infectious Diseases, CHU Tivoli, Belgium
Background: Infective endocarditis in pregnancy is a rare but severe clinical condition, both for the mother and the foetus. Symptoms may be misleading due to their confusion with the expected effects of pregnancy. Case
Presentation: A 37-year-old woman, gravida 7 para 2, pregnant at 17 weeks of gestation was diagnosed with an infective endocarditis caused by streptococcus mitis after a persistent inflammatory syndrome with dry cough. Echocardiography confirmed mitral endocarditis after positive blood cultures, showing a moderate mitral insufficiency with vegetations. At 17 weeks of gestation, the patient underwent cardiac surgery under cardiopulmonary bypass. A successful mitral replacement was carried out without complications. At 22 weeks of gestation, ultrasound demonstrated a major cerebral malformation with hydrocephaly, and abnormal kidneys differentiation. After premature rupture of the membranes at 31 weeks and three days with antibiotics, the patient delivered a girl of 1840 grams, with an Apgar score of 9-8-8. The clinical exam of the baby showed a macrocephaly and a setting-sun sign. The baby died a few hours after delivery.
Conclusion: Treatment of infective endocarditis in pregnancy poses a dilemma due to the balance of risks for the mother and the foetus. As illustrated by our case, when endocarditis occurs early in the pregnancy, the necessary cardiac surgery requires the adoption of specific precautions. Despite these precautions allowing the foetus to survive surgery, severe malformations may lead to newborn’s early death.
Goldman, Riga, Huyong, Van PouckH, Guillaume, Milas, et al. Mitral Endocarditis in Early Pregnancy: Case Report and Mini-Review. J Clin Obstet Gynecol Infertil. 2018; 2(2): 1033.