Maternal outcomes of infective endocarditis in pregnancy: a narrative review of diagnosis and multidisciplinary management

Nishat Altaf Deraiya; Safa Pathan; Sancia Raymond Selwyn; Shiaaneish Arumugam; Yashgauri Wagh; Blessy Kongasseri

doi:10.18203/2320-1770.ijrcog20264248

Authors

Nishat Altaf Deraiya Department of Medicine, Georgian National University SEU, Tbilisi, Georgia
Safa Pathan Department of Medicine, Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
Sancia Raymond Selwyn Department of Medicine, Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
Shiaaneish Arumugam Department of Medicine, AIMST University, Kedah, Malaysia
Yashgauri Wagh Department of Medicine, East European University, Tbilisi, Georgia
Blessy Kongasseri Department of Medicine, Georgian National University SEU, Tbilisi, Georgia

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20264248

Keywords:

Infective endocarditis, Pregnancy, Maternal outcomes, Injection drug use, Cardiac surgery, Multidisciplinary care

Abstract

Infective endocarditis (IE) in pregnancy is rare (incidence about 0.006%) but increasing, driven by injection drug use, prosthetic valves and cardiac devices, and more women with congenital heart disease reaching reproductive age. Pregnancy obscures presentation and constrains diagnosis and treatment, and the evidence is scattered across case reports, small series and retrospective cohorts. This narrative review synthesizes published case reports, case series, cohort studies and reviews on IE in pregnancy and the postpartum period, focusing on maternal outcomes, risk factors, diagnosis and management, with fetal outcomes as a secondary consideration. Risk factors include injection drug use, rheumatic and congenital heart disease, prosthetic valves and intracardiac devices; Staphylococcus aureus predominates. Physiological murmurs, atypical symptoms and other febrile illnesses delay diagnosis. Contemporary maternal in-hospital mortality is 5-17% and, in the two largest comparative datasets, did not differ significantly from that of non-pregnant women. IE diagnosed during the delivery admission is the exception, with 17.2% mortality and severe morbidity in 77.5%. Heart failure, septic embolization and arrhythmia dominate morbidity. Valve surgery rates are similar to those in non-pregnant patients; bypass during pregnancy yields excellent maternal survival but 18-20% fetal mortality, favoring cesarean delivery followed by valve surgery once the fetus is viable. Multidisciplinary care, including addiction medicine, was associated with fewer patient-directed discharges. IE in pregnancy mainly alters recognition and management rather than survival of established disease, except at delivery. Early suspicion, echocardiography, blood cultures, pregnancy-compatible antimicrobials, timing of delivery and surgery, and tertiary multidisciplinary care are central. Prospective registries are needed.

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