A 30-year-old woman with a mechanical mitral valve prosthesis is admitted in early labour. She is afebrile with no signs of infection. Regarding infective endocarditis prophylaxis at delivery:

• A Antibiotic prophylaxis is required for all patients with prosthetic valves undergoing vaginal delivery
• B Prophylaxis is not recommended for uncomplicated vaginal or caesarean delivery, even with a prosthetic valve ✓
• C Prophylaxis is required only for caesarean delivery with a prosthetic valve
• D Prophylaxis is required only if the patient is also on warfarin

Explanation

Current AHA and ESC guidance states that infective endocarditis prophylaxis is not indicated for routine vaginal or caesarean delivery, even in women with prosthetic valves or previous endocarditis, provided there is no evidence of infection. Genital tract bacteraemia at delivery is transient and the cost and allergy risks outweigh any proven benefit. Prophylaxis becomes relevant only when suspected intra-amniotic infection or bacteraemia is present, which this afebrile patient does not have.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.