Seaworth B J, Durack D T
Am J Obstet Gynecol. 1986 Jan;154(1):180-8. doi: 10.1016/0002-9378(86)90422-9.
Infective endocarditis is an important but uncommon complication in obstetric or gynecologic practice; we found only 124 cases reported in English and selected European papers during the last 40 years. The majority of cases (74%) were caused by streptococci; viridans streptococci predominated, while enterococci and group B streptococci were uncommon except after abortion. The overall mortality rate was 29%, while the mortality rate for the fetus when the mother developed infective endocarditis was 23%. The incidence of endocarditis in this setting is low and seems to be decreasing. Therefore, the risk-benefit ratio may not favor routine use of prophylaxis for endocarditis. We conclude that antibiotics need not be given for prevention of endocarditis before most common obstetric and gynecologic procedures. These include uncomplicated vaginal deliveries, uncomplicated spontaneous or induced abortions, dilatation and curettage, insertion or removal of intrauterine contraceptive devices (in the absence of pelvic infection), and biopsies of the cervix. For patients in whom both the underlying heart lesion and the obstetric or gynecologic procedure seem to pose significant risk for endocarditis, prophylaxis should be given. Two parenteral regimens for patients at highest risk are recommended: ampicillin plus gentamicin or vancomycin plus gentamicin. For lower-risk situations, one oral regimen is suggested: amoxicillin.
感染性心内膜炎是妇产科实践中一种重要但不常见的并发症；在过去40年里，我们在英文及选定的欧洲文献中仅发现124例相关报道。大多数病例（74%）由链球菌引起；其中草绿色链球菌占主导，而肠球菌和B族链球菌除流产后外并不常见。总体死亡率为29%，母亲发生感染性心内膜炎时胎儿的死亡率为23%。这种情况下心内膜炎的发病率较低且似乎在下降。因此，风险效益比可能不支持常规使用心内膜炎预防措施。我们得出结论，在大多数常见的妇产科手术前，无需给予抗生素预防心内膜炎。这些手术包括无并发症的阴道分娩、无并发症的自然流产或人工流产、刮宫术、宫内节育器的置入或取出（无盆腔感染时）以及宫颈活检。对于基础心脏病变以及妇产科手术似乎都对心内膜炎构成重大风险的患者，应给予预防措施。对于风险最高的患者，推荐两种胃肠外给药方案：氨苄西林加庆大霉素或万古霉素加庆大霉素。对于风险较低的情况，建议一种口服给药方案：阿莫西林。
