Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2014 Aug;89(8):1143-52. doi: 10.1016/j.mayocp.2014.04.024. Epub 2014 Jul 1.
The objective of this review was to describe the clinical characteristics, risk factors, and outcomes of infective endocarditis (IE) in pregnancy and the postpartum period. We conducted a systematic review of Ovid MEDLINE, Ovid Embase, Web of Science, and Scopus from January 1, 1988, through October 31, 2012. Included studies reported on women who met the modified Duke criteria for the diagnosis of IE and were pregnant or postpartum. We included 72 studies that described 90 cases of peripartum IE, mostly affecting native valves (92%). Risk factors associated with IE included intravenous drug use (14%), congenital heart disease (12%), and rheumatic heart disease (12%). The most common pathogens were streptococcal (43%) and staphylococcal (26%) species. Septic pulmonary, central, and other systemic emboli were common complications. Of the 51 pregnancies, there were 41 (80%) deliveries with survival to discharge, 7 (14%) fetal deaths, 1 (2%) medical termination of pregnancy, and 2 (4%) with unknown status. Maternal mortality was 11%. Infective endocarditis is a rare, life-threatening infection in pregnancy. Risk factors are changing with a marked decrease in rheumatic heart disease and an increase in intravenous drug use. The cases reported in the literature were commonly due to streptococcal organisms, involved the right-sided valves, and were associated with intravenous drug use.
本综述的目的是描述妊娠和产后感染性心内膜炎（IE）的临床特征、危险因素和结局。我们对 1988 年 1 月 1 日至 2012 年 10 月 31 日期间 Ovid MEDLINE、Ovid Embase、Web of Science 和 Scopus 进行了系统检索。纳入的研究报告了符合改良 Duke 标准诊断为 IE 且处于妊娠或产后的女性。我们纳入了 72 项研究，共描述了 90 例围产期 IE，主要影响原生瓣膜（92%）。IE 的相关危险因素包括静脉吸毒（14%）、先天性心脏病（12%）和风湿性心脏病（12%）。最常见的病原体是链球菌（43%）和葡萄球菌（26%）。感染性肺、中枢和其他全身栓塞是常见的并发症。在 51 例妊娠中，有 41 例（80%）分娩后存活，7 例（14%）胎儿死亡，1 例（2%）终止妊娠，2 例（4%）状态不明。母体死亡率为 11%。IE 在妊娠中是一种罕见的、危及生命的感染。随着风湿性心脏病的明显减少和静脉吸毒的增加，危险因素也在发生变化。文献中报告的病例通常由链球菌引起，涉及右侧瓣膜，与静脉吸毒有关。
