ABSTRACT
Infectious endocarditis superimposed upon pregnancy is a rare condition (Figure 69.1). The estimated incidence is 0.005-0.015% of pregnancies. The associated maternal mortality is a partial function of therapy. In the pre-antibiotic area, the maternal and fetal mortalities approached 75-100%. With antibiotic therapy, maternal mortality has decreased to an approximate 30%, and even this figure is misleading because of the increasing reliance on valve replacement when confronted with indications for cardiac surgery. Maternal mortality for women whose pregnancies are complicated by infectious endocarditis is four times that of women cured of endocarditis prior to pregnancy
Infectious endocarditis in pregnancy involves three high-risk groups:
(1) acute disease in gravidas undergoing abortion and subsequent sepsis; (2) gravidas with high velocity flow cardiac lesions, i.e. bicuspid aortic valves,
ventricular septal defect, or lesions such as idiopathic hyper-tropic subaortic stenosis and probably mitral valve prolapse. Atrial septal defects are low pressure cardiac lesions and hence are not at augmented risk for infectious endocarditis; and
(3) gravidas who are parenteral drug abusers.
