Affiliation:
1. Department of Obstetrics, The First Affiliated Hospital, College of Medicine, Zhejiang University
Abstract
Abstract
Background: Infective endocarditis (IE) is a rare disease that occurs during pregnancy. The incidence of embolic complications associated with IE is high, reaching up to 50%, with spleen being the most commonly affected organ at 32.8%. Despite this, there is a significant global lack of reports on splenic infarction (SI) resulting from IE during pregnancy.
Case presentation: A 33-year-old pregnant woman was admitted to our hospital at 29 3/7 weeks' gestation, presenting with symptoms of hyperpyrexia, abdominal pain, and diarrhea. She had undergone mechanical MVR due to rheumatic heart disease and had been on warfarin therapy for a duration of nine years. Our initial diagnosis was gastroenteritis. During her hospitalization, she experienced mild and persistent left upper quadrant abdominal pain. Abdominal ultrasound suggested a potential splenic infarction. However, transthoracic echocardiography and transesophageal echocardiography confirmed normal mechanical valve function without any vegetation findings. We administered anti-inflammatory and anti-coagulation treatments. The patient unexpectedly terminated the pregnancy via cesarean section due to PROM. Warfarin was retained prior to the surgery and resumed post-surgery. Additionally, therapy with IH low-molecular-weight heparin was administered, a strategy known as bridging strategy.
Conclusion: Pregnant women with a history of MVR can develop IE. Although the occurrence is rare, these individuals are at potential risk for splenic infarction when undergoing anticoagulant therapy. The management approach during pregnancy requires a collaborative effort from multidisciplinary team and must be tailored to the individual patient.
Publisher
Research Square Platform LLC