Abstract
Infective endocarditis (IE) is a serious and potentially fatal infection affecting cardiac endothelium and valves, with a significant increase in its incidence. This comprehensive review aims to discuss the challenges of diagnosing and managing IE during pregnancy, highlighting the absence of research and randomized clinical trials. Despite its low occurrence, IE in pregnancy is associated with significant maternal and fetal mortality rates, often complicated by prematurity. This review covers the physiological changes during pregnancy that can mask the symptoms of IE and the epidemiological shift in risk factors, including the rise in opioid addiction and the use of cardiac devices. It also sheds light on the specific microorganisms responsible for most IE cases. This paper involved a detailed search of PubMed databases, focusing on studies related to IE in pregnant patients, including those addressing fetal and maternal outcomes. It highlights the diagnostic challenges posed by the physiological changes in pregnancy, the impact of IE on maternal and fetal health, and the lack of specific treatment guidelines for pregnant women. We stress on the importance of a multidisciplinary approach to care, aiming to enhance early diagnosis, effective patient care strategies, and overall outcomes for this vulnerable population. Finally, our findings underscore the need for more research and the development of evidence-based guidelines to improve the management of IE in pregnancy.
Similar content being viewed by others
Avoid common mistakes on your manuscript.
Introduction
Infective endocarditis (IE) is a serious and potentially fatal infection caused by various types of microorganisms. IE primarily affects the cardiac endothelium and cardiac valves [1, 2]. Although rare, there has been a notable rise in the incidence of IE by twofold from 478,000 cases in 1990 to 1,090,530 cases in 2019, resulting in greater morbidity and mortality [3]. In industrialized countries, infective endocarditis has an estimated annual incidence of three to nine cases per 100,000 persons [4]. This rise in incidence has been linked to epidemiological changes in the industrialized world, a rise in opioid addiction, and a greater proportion of cardiac devices and prosthetic valves [5]. Notably, the cost of IE hospitalizations was estimated to have risen to $2.34 billion in 2016 [6]. It is crucial to remain aware of the occurrence of IE in special population groups, such as pregnant women, in this constantly changing world, and most importantly the need of a comprehensive multidisciplinary approach to care.
In the current literature, there is a significant lack of comprehensive understanding of IE in the antepartum and postpartum periods in pregnant patients, including management of feto-maternal complications. This is largely due to the limited data available because of the low reported incidence and lack of randomized controlled trials. Despite its low incidence (estimated at 0.006%), IE in pregnancy has associated with significant maternal mortality of up to 33% and fetal mortality of 14% [7,8,9]. Prematurity is a major concern of pregnancies complicated by IE, with over half of deliveries occurring prior to term (averaging at 32 weeks of gestation) [10]. This can lead to significant perinatal morbidity and mortality. This review aims to provide a comprehensive overview of research on IE in pregnancy and associated complications. Our analysis covers the physiological changes that occur in pregnancy, key risk factors, potential preventative strategies, fetal and maternal outcomes, management in this group, and future research directions. By understanding the complex relationship between the pregnant body and its response to infections, we hope to guide and inform clinical practice. Our ultimate goal is to contribute to early diagnosis, improved patient care strategies, and better outcomes for this highly vulnerable patient population.
Methodology
A comprehensive search of the PubMed databases was performed from inception to December 2023 to identify relevant articles. Different medical subject headings (MeSH) terms were used, including “Infective Endocarditis,” “Bacterial Endocarditis,” “Endocarditis,” “Pregnancy,” “Post-Partum,” “Peri-partum,” “Pregnant,” and “Heart Failure” were used to generate the search strategy.
Inclusion Criteria
Studies were included in this review if they met the following criteria:
-
1.
Conducted in pregnant patients
-
2.
Focused on IE
-
3.
Included information on presentation of IE
-
4.
Discussed different fetal and maternal outcomes
-
5.
Published in the English language
Exclusion Criteria
Studies were excluded in this review if they met the following criteria:
-
1.
Studies that were not conducted on human subjects.
-
2.
Case reports and papers not published in the English language.
Data Extraction and Analysis
Two reviewers screened the titles and abstracts of all identified studies to determine eligibility for inclusion. The full-text articles of potentially eligible studies were then obtained and reviewed in detail by the same reviewers. Any discrepancies between the two reviewers were resolved through discussion and consensus. The extracted data included study design, patient characteristics, interventions, outcomes, and adverse events. The data was summarized qualitatively due to the heterogeneity of the included studies.
Physiologic Changes of Pregnancy
It is essential to understand that several inherent physiological changes occur to the human body during pregnancy. These changes can affect the clinical presentation and possibly delay diagnosis of endocarditis in pregnancy. For instance, there is an overall increase in cardiac strain. Typical cardiac changes include an increase in preload by almost 50%, elevation of the heart rate, and an increase in cardiac output [11, 12]. Simultaneously, there is a significant decrease in peripheral vascular resistance, resulting in an overall decrease in afterload and systemic blood pressure [13]. These hemodynamic alterations are observed later in pregnancy, particularly during the second and third trimester, as well as in the postpartum period [13, 14]. Various changes to cardiac valves can cause the presence of murmurs during physical examination, which can be difficult to interpret and may be misleading. According to literature, pregnant patients often show enlarged mitral and tricuspid rings and some degree of valvular insufficiency with the highest incidence in right heart valves, estimated at > 90% in tricuspid and pulmonary valves [13,14,15]. In addition, the myocardium of pregnant patients adapts to this physiological state of volume overload, leading to benign left ventricular hypertrophy as well as a short-term systolic and diastolic dysfunction [16].
During pregnancy, the immune system of the mother gets regulated to be able to adjust and maintain the well-being of the mother and the fetus. There is a common misconception that pregnancy is an immunosuppressed state due to complex immune changes. At the materno-fetal interface, the immune system undergoes significant reprograming to accommodate for the developing fetus, which can lead to different responses to different organisms [17]. The overall implicated changes include a decrease in adaptive immunity (specifically B cell cytotoxic function) and an overall increase in innate immunity (coordinated cell migration and pathogen recognition) [17]. This sheds the light on the importance of recognizing distinct physical exam findings of IE during encounters with pregnant women.
Risk Factors
The European Society of Cardiology (ESC) identifies three distinct groups of patients at an increased risk of developing IE: individuals with prosthetic valves, cyanotic congenital heart disease (CHD), and those with a previous history of IE [18]. Patients with prosthetic valves face an increased susceptibility to IE and are more prone to complications compared to those with native valves [19]. Those with untreated CHD or who have undergone surgical interventions such as shunts, conduits, or other prosthesis are also at elevated risk, prompting the task force to recommend prophylaxis for 6 months post-surgery [20]. Similarly, individuals with a history of IE carry a greater risk of recurrence, along with elevated mortality rates and incidence of complications [21].
Despite the lack of differences in the risk factors for IE among pregnant and non-pregnant individuals, there has been an overall change in the prevalence of risk factors in the past couple of decades. Common risk factors for IE include chronic comorbidities (such as diabetes mellitus, hypertension, end-stage renal disease), underlying heart disease, implantable cardiac devices, prosthetic valves, prolonged intravenous access, and intravenous drug use [22, 23]. Episodes of bacteremia significantly contribute to the development of endocarditis. Several procedures are frequently associated with transitory bacteremia such as dental work, genitourinary, and gastrointestinal instrumentation. As microorganisms infiltrate the bloodstream, they have the propensity to adhere to damaged endothelium which facilitates vegetation formation [24, 25]. Additionally, childbirth may introduce another layer of risk, particularly in situations that might favor bacteremia such as membrane ruptures, manual removal of the placenta, prolonged labor, and even low socioeconomic status [26]. In a prospective cohort study done by Sengupta et al., patients with IE in lower to middle income countries were younger than patients with IE in higher income countries at presentation, presented later (52 days since symptom onset in lower income countries compared to 30 days in higher income countries, p < 0.001), had less access to advanced cardiac imaging, underwent surgery less frequently, and had a higher mortality all in all (mortality rate of 23% in lower income countries compared to 15% in higher income countries, p < 0.001) [27]. It is noteworthy that the current literature has yet to investigate whether pregnancy potentiates the risk for IE in individuals with pre-existing cardiac risk factors such as prosthetic valves, CHD, or a history of previous IE.
In the general population nowadays, a prominent contributing risk for bacteremia is intravenous drug use (IVDU), which has been markedly increasing in prevalence, consequently leading to increasing rates of right-sided IE [28]. Different studies have identified IVDU as the predominant extracardiac risk factor for IE during pregnancy, observed in 23% of 61 patients with pregnancy and postpartum IE between 2014 and 2020 [9, 29]. The United States and Eastern Europe have reported higher rates of drug use compared to other counties, potentially predisposing these specific populations. Furthermore, preexisting heart disease remains a significant risk for both the general population and pregnant patients. Despite a notable decrease in the incidence of rheumatic heart disease, there has been a concomitant increase in individuals with congenital cardiac conditions who survive to adulthood and childbearing age [9, 30].
Microorganisms
Streptococcus, Staphylococcus aureus, and Enterococcus are the microorganisms responsible for most cases of IE in both pregnant and non-pregnant patients, with Staphylococcus aureus being the most common causative organism. The American Heart Association (AHA) and American College of Cardiology (ACC) have described a significant rise in overall Staphylococcus aureus endocarditis, attributing it to increased use of cardiac devices, prosthetic valves, and the rise of IVDU alongside industrialization [5].
The impact of Staphylococcus endocarditis extends beyond pregnancy, as multiple studies identify it as the most common causal organism followed by streptococcus species [9]. De Oliviera et al. found that Staphylococcus aureus accounted for approximately 33% of cases, while Streptococcus viridans group constituted 26% [29]. Importantly, there is a significantly lower incidence of beta-hemolytic Streptococcus, attributed to antenatal care and screening for Streptococcus agalactiae [29]. Despite scarcity of literature on perinatal and postnatal IE, certain case reports have shed a light on unusual organisms and on IE in pregnant patients with no common risk factors. A case report from Turkey documented a case of postpartum IE with Enterococcus in a 24-year-old female who underwent a vaginal delivery, with the performance of an episiotomy being identified as a significant risk factor [31]. The awareness of the genitourinary instrumentation during the peripartum period should raise suspicion regarding the potential development of IE postpartum.
Diagnosis of Infective Endocarditis in Pregnancy
The intricate and constantly changing epidemiology poses a persistent diagnostic challenge. Over the years, diagnostic criteria have been established to help in the recognitions of IE. The AHA/ACC and European Society of Cardiology (ESC) have comprehensively reviewed the diagnostic process, with no specific adjustments suggested when diagnosing IE in pregnancy [5, 18]. In 2015, the ESC IE guidelines noted special consideration to the cardiac physiologic changes of pregnancy that may mimic cardiac disease, such as murmurs during physical examination, potentially complicating the clinical picture [18].
The diagnosis of IE primarily relies on the Duke Criteria for IE, which has been revised into the 2023 Duke-ISCVID criteria (International Society for Cardiovascular Infectious Disease Criteria for Infectious Diseases) [32]. Table 1 shows the updated Duke-ISCVID diagnostic criteria with description of the major and minor diagnostic criteria. Duke-ISCVID criteria operate as a point system, facilitating the diagnosis of IE by categorizing cases as definitive, possible, and rejected IE (described in Table 2), based on the presence of major and minor criteria.
Validation studies on the 2023 Duke-ISCVID criteria have been conducted, with two noteworthy researches. In Amsterdam, a study involving 595 patients with suspected found that the 2023 Duke-ISCVID Criteria exhibited greater sensitivity in diagnosing IE compared to the modified Duke criteria (2000) and ESC 2015 criteria [33]. Another study performed in France with a patient population of 1194 similarly found a higher sensitivity with 2023 Duke-ISCVID Criteria compared to modified Duke and ESC 2015 criteria [34].
Materno-Fetal Outcomes and Complications
While women with IE face a range of various complications, a notable distinction during pregnancy is the heightened mortality risk, along with fetal complications arising from premature delivery. Similar to the general population, pregnant women with IE may experience adverse outcomes such as heart failure, worsening infection, systemic emboli, aneurysm, and preterm birth. The morbidity rate is significantly increased in pregnant patients and is particularly associated with prolonged hospital stay [35].
Heart failure is a frequent complication of IE, primarily caused by severe valvular regurgitation and cardiac fistula formation and often necessitates surgery [36]. In the context of pregnancy, the acute deterioration in cardiac function may warrant an emergency cardiac surgery, exposing the maternal body to the elevated stressors of such a procedure and the risks of complications. The initiation of antibiotics prior to cardiac surgery is recommended, with one study indicating that pregnant patients typically received an average of 18 days of antibiotic therapy prior to cardiac surgery [1, 37]. Risks are notably elevated when interventions are performed in earlier gestational periods. Some studies suggest deferring cardiac operations until after 28 weeks of gestation due to the increased risk of fetal demise [38]. Intraoperative cardiotocography plays a crucial role in these surgeries, given that cardiopulmonary bypass is associated with acute decompensation of the fetus along with high fetal mortality [39, 40].
Shapero et al. shed the light on the increased rates of complications, with all studied patients experiencing adverse outcomes from IE. Fetal outcomes predominantly involve prematurity, with average birth occurring at 32 gestational weeks, accompanied by the risk of fetal demise [35]. The repercussions of fetal prematurity are numerous, encompassing various complications such as infections, low birthweight, respiratory distress syndrome, and intraventricular hemorrhage. Likewise, fetal complications are linked with neurodevelopmental issues, although long-term pediatric outcomes in these cases have not been thoroughly investigated [41, 42]. In a notable study, it was observed that nearly half of infants born to mother with IE required admission to the neonatal intensive care unit, with an average length of stay of 44 days [35]. Prenatal monitoring and understanding disease progression in the pregnant patient with IE is closely related to postnatal outcomes.
Treatment
Despite the existence of different guidelines providing recommendations for antimicrobial treatment of IE in the general population, there is a notable absence of dedicated recommendations for IE during pregnancy. In general, antibiotic therapy is directed towards the organisms isolated from blood cultures. Due to limited literature and the absence of a major consensus, the initial antimicrobial treatment typically involves the empiric coverage with anti-staphylococcal beta-lactams in pregnancy, considering their established safety in pregnancy [35, 43]. These management measures are implemented based on the assumption that the causal organism will most likely be equivalent to the most common organisms that infect non-pregnant persons. In patients with IE of a native valve, the recommended duration of antibiotic therapy is 4 to 6 weeks. In patients with IE of a prosthetic valve, the recommended duration of antibiotic therapy is 6 weeks. There are special factors that require a prolonged treatment with antibiotics, such as left-sided vegetations, drug-resistant organisms, and the use of slowly bactericidal agents such as vancomycin [5, 31]. Literature dedicated to the pregnant patient population is limited, and more research efforts dedicated to developing guidelines for guidance of treatment of IE in pregnancy are needed.
Prevention and Antimicrobial Prophylaxis
The AHA/ACC has issued guidelines specifying the conditions and procedures that would warrant antibiotic prophylaxis to prevent IE, and the American College of Obstetrics and Gynecology (ACOG) adopted these recommendations for the pregnant patient [44]. Most antibiotic prophylaxis trials utilize bacteremia as an endpoint, aiming to protect the patient during procedures with increased risk for bacteremia [45]. The ESC provides Class I recommendation for the use of antimicrobial prophylaxis in high-risk procedures for patients with any prosthetic cardiac valve and any type of congenital heart disease, with dental procedures being the primary high-risk procedures [46]. AHA/ACOG guidelines do not recommend the use of routine antibiotic prophylaxis during vaginal or cesarean deliveries, as there is insufficient evidence from compelling studies demonstrating an associated increase in bacteremia that would risk the development of IE postnatally.
Conclusion
Infective endocarditis represents a rare yet life-threatening infection during pregnancy and the postpartum period, requiring a high level of suspicion for early diagnosis and prompt initiation of appropriate management. The severity of IE during pregnancy necessitates a comprehensive multidisciplinary approach involving obstetricians, neonatologists, and the endocarditis team. Managing pregnancy and the postpartum period in the context of IE poses a significant challenge, particularly if cardiac surgery becomes a necessary consideration during the course of disease. Effectively navigating the complexities of IE in pregnancy necessitates a collaborative approach. Clinicians and researchers must work together in order to develop evidence-based guidelines accounting for the unique challenges of IE in pregnancy.
Data Availability
Not applicable.
Code Availability
Not applicable.
References
Yuan S-M. Infective endocarditis during pregnancy. J Coll Phys Surg-Pak. 2015;25(2):134–9.
Rajani R, Klein JL. Infective endocarditis: a contemporary update. Clin Med (Lond, Engl). 2020;20(1):31–5. https://doi.org/10.7861/clinmed.cme.20.1.1.
Chen H, et al. The global, regional, and national burden and trends of infective endocarditis from 1990 to 2019: results from the Global Burden of Disease Study 2019. Front Med. 2022;9(774224):9. https://doi.org/10.3389/fmed.2022.774224.
Hoen B, Duval X. Infective endocarditis. New Engl J Medicinevol. 2013;369(8):785. https://doi.org/10.1056/NEJMc1307282.
Baddour LM, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015;132(15):1435–86. https://doi.org/10.1161/CIR.0000000000000296.
Alkhouli M, et al. Clinical and economic burden of hospitalizations for infective endocarditis in the United States. Mayo Clinic Proc. 2020;95(5):858–66. https://doi.org/10.1016/j.mayocp.2019.08.023.
Shapero K, et al. Outcomes of endocarditis in pregnancy: a single-center experience. Open Forum Infect Dis. 2023;10(9):470. https://doi.org/10.1093/ofid/ofad470.
Sinner GJ, et al. Infective endocarditis in pregnancy from 2009 to 2019: the consequences of injection drug use. Infect Dis (Lond, Engl). 2021;53(8):633–9. https://doi.org/10.1080/23744235.2021.1912821.
Kebed KY, et al. Pregnancy and postpartum infective endocarditis: a systematic review. Mayo Clinic Proc. 2014;89(8):1143–52. https://doi.org/10.1016/j.mayocp.2014.04.024.
Dagher MM, et al. Maternal and fetal outcomes associated with infective endocarditis in pregnancy. Clin Infect Dis. 2021;73(9):1571–9. https://doi.org/10.1093/cid/ciab533.
Martins LC, et al. Risk prediction of cardiovascular complications in pregnant women with heart disease. Arq Bras de Cardiol. 2016;106(4):289–96. https://doi.org/10.5935/abc.20160028.
Liu LX, Arany Z. Maternal cardiac metabolism in pregnancy. Cardiovasc Res. 2014;101(4):545–53. https://doi.org/10.1093/cvr/cvu009.
Martin S, Arafeh J. Cardiac disease in pregnancy. AACN Adv Crit Care. 2018;29(3):295–302. https://doi.org/10.4037/aacnacc2018615.
Anthony J, Sliwa K. Decompensated heart failure in pregnancy. Cardiac Fail Rev. 2016;2(1):20–6. https://doi.org/10.15420/cfr.2015:24:2.
Pessel C, Bonanno C. Valve disease in pregnancy. Semin Perinatol. 2014;38(5):273–84. https://doi.org/10.1053/j.semperi.2014.04.016.
Schannwell CM, et al. Left ventricular hypertrophy and diastolic dysfunction in healthy pregnant women. Cardiology. 2002;97(2):73–8. https://doi.org/10.1159/000057675.
Mor Gil, Cardenas Ingrid. The immune system in pregnancy: a unique complexity. Am J Reprod Immunol. 2010;63(6):425–33. https://doi.org/10.1111/j.1600-0897.2010.00836.x. (New York, N.Y. : 1989).
Habib Gilbert, et al. ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36(44):3075–128. https://doi.org/10.1093/eurheartj/ehv319.
Lalani T, Chu VH, Park LP, Cecchi E, Corey GR, Durante-Mangoni E, Fowler VG Jr, Gordon D, Grossi P, Hannan M, Hoen B, Munoz P, Rizk H, Kanj SS, Selton-Suty C, Sexton DJ, Spelman D, Ravasio V, Tripodi MF, Wang A. In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis. JAMA Intern Med. 2013;173:1495–504.
Chu VH, Sexton DJ, Cabell CH, Reller LB, Pappas PA, Singh RK, Fowler VG Jr, Corey GR, Aksoy O, Woods CW. Repeat infective endocarditis: differentiating relapse from reinfection. Clin Infect Dis. 2005;41:406–9.
Baumgartner H, Bonhoeffer P, De Groot NM, de Haan F, Deanfield JE, Galie N, Gatzoulis MA, Gohlke-Baerwolf C, Kaemmerer H, Kilner P, Meijboom F, Mulder BJ, Oechslin E, Oliver JM, Serraf A, Szatmari A, Thaulow E, Vouhe PR, Walma E. ESC Guidelines for the management of grown-up congenital heart dis- ease (new version 2010). Eur Heart J. 2010;31:2915–57.
Vincent LL, Otto CM. Infective endocarditis: update on epidemiology, outcomes, and management. Curr Cardiol Rep. 2018;20(10):86. https://doi.org/10.1007/s11886-018-1043-2.
Tleyjeh IM, et al. A systematic review of population-based studies of infective endocarditis. Chest. 2007;132(3):1025–35. https://doi.org/10.1378/chest.06-2048.
Cabell CH, et al. Cardiology patient page. Bacterial endocarditis: the disease, treatment, and prevention. Circulation. 2003;107(20):e185-7. https://doi.org/10.1161/01.CIR.0000071082.36561.F1.
Moreillon P, Que Y-A. Infective endocarditis. Lancet (London, England). 2004;363(9403):139–49. https://doi.org/10.1016/S0140-6736(03)15266-X.
van Schalkwyk Julie, et al. Antibiotic prophylaxis in obstetric procedures. J Obstet Gynaecol Canada. 2010;32(9):878–84. https://doi.org/10.1016/S1701-2163(16)34662-X.
Sengupta SP, et al. Socioeconomic variations determine the clinical presentation, aetiology, and outcome of infective endocarditis: a prospective cohort study from the ESC-EORP EURO-ENDO (European Infective Endocarditis) registry. Eur Heart J Qual Care Clin Outcomes. 2022;9(1):85–96. https://doi.org/10.1093/ehjqcco/qcac012.
de Sa C, Daniel D, et al. Epidemiological trends of infective endocarditis: a population-based study in Olmsted County. Minnesota Mayo Clinic Proc. 2010;85(5):422–6. https://doi.org/10.4065/mcp.2009.0585.
de Oliveira FM, Fraife MT, Barbosa G, Monteiro TS, Lamas C. Endocarditis in pregnancy and postpartum: cases in a prospective adult cohort and literature review. Heart Vessels Transplant. 2022;6(4):178. https://doi.org/10.24969/hvt.2022.343.
Campuzano K, et al. Bacterial endocarditis complicating pregnancy: case report and systematic review of the literature. Arch Gynecol Obstet. 2003;268(4):251–5. https://doi.org/10.1007/s00404-003-0485-x.
Dural IE, et al. Postpartum infective endocarditis with Enterococcus faecalis after vaginal delivery. Anatol J Cardiol. 2021;25(12):920–1. https://doi.org/10.5152/AnatolJCardiol.2021.29797.
Fowler VG, et al. The 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria for infective endocarditis: updating the modified Duke criteria. Clin Infect Dis. 2023;77(4):518–26. https://doi.org/10.1093/cid/ciad271.
van der Vaart TW, Bossuyt PMM, Baddour LM, Bayer AS, Durack DT, Durante Mangoni E, Holland TL, Karchmer AW, Miró JM, Moreillon P, Rasmussen M, Selton-Suty C, Fowler VG, van der Meer JTM. 963 External validation of the 2023 Duke - International Society for Cardiovascular Infectious Diseases (ISCVID) diagnostic criteria for infective endocarditis (IE). Open Forum Infect Dis. 2023;10(Suppl 2):ofad500.024. https://doi.org/10.1093/ofid/ofad500.024.
Goehringer F, Lalloué B, Selton-Suty C, Alla F, Baronnet G, Botelho-Nevers E, Chirouze C, Curlier E, Hatimi SE, Erpelding ML, Escaut L, Gagneux-Brunon A, Gun M, Lefèvre B, Le Moing V, Piroth L, Mandjee AR, Sixt T, Strady C, Tissot N, Tribouilloy C, Virion JM, Agrinier N, Duval X, Bruno H. 2400 Compared performance indices of the 2023 Duke-ISCVID, the 2000 Modified Duke, and the 2015 ESC Criteria for the Diagnosis of Infective Endocarditis. Open Forum Infect Dis. 2023;10(Suppl 2):ofad500.2020. https://doi.org/10.1093/ofid/ofad500.2020.
Shapero Kayle S, et al. Management of infective endocarditis in pregnancy by a multidisciplinary team: a case series. Ther Adv Infect Dis. 2022;9:20499361221080644. https://doi.org/10.1177/20499361221080644.
Tornos P, et al. Infective endocarditis in Europe: lessons from the Euro heart survey. Heart (British Cardiac Society). 2005;91(5):571–5. https://doi.org/10.1136/hrt.2003.032128.
Vizzardi Enrico, et al. Infectious endocarditis during pregnancy, problems in the decision-making process: a case report. Cases J. 2009;2:6537. https://doi.org/10.4076/1757-1626-2-6537.
Mahli A, et al. Cardiac operations during pregnancy: review of factors influencing fetal outcome. Ann Thorac Surg. 2000;69(5):1622–6. https://doi.org/10.1016/s0003-4975(00)01178-4.
Patel C, et al. Pregnancy and cardiac interventions: what are the optimal management options? J Card Surg. 2020;35(7):1589–96. https://doi.org/10.1111/jocs.14637.
Güler Adem, et al. A case of infective endocarditis, during pregnancy: should we keep the fetus? Anadolu Kardiyol Derg. 2010;10(3):291–2. https://doi.org/10.5152/akd.2010.076.
Bourke Jenny, et al. Predicting long-term survival without major disability for infants born preterm. J Pediatr. 2019;215:90-97.e1. https://doi.org/10.1016/j.jpeds.2019.07.056.
Klebermass-Schrehof K, et al. Impact of low-grade intraventricular hemorrhage on long-term neurodevelopmental outcome in preterm infants. Child’s Nerv Sys. 2012;28(12):2085–92. https://doi.org/10.1007/s00381-012-1897-3.
Ulloa ER, et al. Cefazolin and ertapenem salvage therapy rapidly clears persistent methicillin-susceptible Staphylococcus aureus bacteremia. Clin Infect Dis. 2020;71(6):1413–8. https://doi.org/10.1093/cid/ciz995.
American College of Obstetricians and Gynecologists. ACOG practice bulletin number 47, October 2003: prophylactic antibiotics in labor and delivery. Obstet Gynecol. 2003;102(4):875–82. https://doi.org/10.1016/s0029-7844(03)00984-0.
Cahill TJ, et al. Antibiotic prophylaxis for infective endocarditis: a systematic review and meta-analysis. Heart (British Card Socy). 2017;103(12):937–44. https://doi.org/10.1136/heartjnl-2015-309102.
Lockhart P, et al. Bacteremia associated with toothbrushing and dental extraction. Circulation. 2008;117(24):3118–25. https://doi.org/10.1161/CIRCULATIONAHA.107.758524.
Author information
Authors and Affiliations
Contributions
All of the authors listed have contributed significantly to this publication. G.W. and C.L. performed primary data collection and prepared the manuscript. N.A. and J.L. contributed by revising the manuscript critically for important intellectual content. M.M. provided infectious diseases expertise, mentorship, and guidance of manuscript preparation.
All authors have read and agreed to the published version of the manuscript.
Corresponding author
Ethics declarations
Ethical Approval
Not applicable.
Consent to Participate
Not applicable.
Consent for Publication
Not applicable.
Competing Interests
The author declares no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Wahbah Makhoul, G., Lahoud, C., Asogwa, N. et al. Infective Endocarditis in Pregnancy: Unveiling the Challenges, Outcomes, and Strategies for Management. SN Compr. Clin. Med. 6, 66 (2024). https://doi.org/10.1007/s42399-024-01694-2
Accepted:
Published:
DOI: https://doi.org/10.1007/s42399-024-01694-2