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INFECTIVE ENDOCARDITIS IN PREGNANT WOMEN WITHOUT INTRAVENOUS DRUG USE: A MULTICENTRE RETROSPECTIVE CASE SERIES
https://www.arca.fiocruz.br/handle/icict/55912
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Abstract
Objectives: To describe the clinical features and outcomes of infective endocarditis (IE) in pregnant women who do not inject drugs. Methods: A multinational retrospective study was performed at 14 hospitals. All definite IE episodes between January 2000 and April 2021 were included. The main outcomes were maternal mortality and pregnancy-related complications. Results: Twenty-five episodes of IE were included. Median age at IE diagnosis was 33.2 years (IQR 28.3–36.6) and median gestational age was 30 weeks (IQR 16–32). Thirteen (52%) patients had no previously known heart disease. Sixteen (64%) were native IE, 7 (28%) prosthetic and 2 (8%) cardiac implantable electronic device IE. The most common aetiologies were streptococci (n=10, 40%), staphylococci (n=5, 20%), HACEK group (n=3, 12%) and Enterococcus faecalis (n=3, 12%). Twenty (80%) patients presented at least one IE complication; the most common were heart failure (n=13, 52%) and symptomatic embolism other than stroke (n=4, 16%). Twenty-one (84%) patients had surgery indication and surgery was performed when indicated in 19 (90%). There was one maternal death and 16 (64%) patients presented pregnancyrelated complications (11 patients ≥1 complication): 3 pregnancy losses, 9 urgent Caesarean sections, 2 emergency Caesarean sections, 1 fetal death, and 11 preterm births. Two patients presented a relapse during a median follow-up of 3.1 years (IQR 0.6–7.4). Conclusions: Strict medical surveillance of pregnant women with IE is required and must involve a multidisciplinary including obstetricians and neonatologists. Furthermore, the potential risk of IE during pregnancy should never be underestimated in women with previously known underlying heart disease.
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