A 26-year-old woman with rheumatic mitral stenosis, NYHA Class II, is admitted in spontaneous labour at term. She is febrile with clear chest and no focus of infection. Regarding prevention of infective endocarditis at delivery:

• A Antibiotic prophylaxis is mandatory before every vaginal delivery in all structural heart disease
• B Antibiotic prophylaxis is required only if she has a prosthetic valve
• C Antibiotic prophylaxis is required only for caesarean section
• D Antibiotic prophylaxis is not routinely indicated for vaginal or caesarean delivery unless there is suspected infection ✓

Explanation

AHA and ESC guidance states that infective endocarditis prophylaxis is not indicated for uncomplicated vaginal or caesarean delivery, because bacteraemia rates during labour are comparable to everyday activities such as tooth brushing. Antibiotics are given only when infection is suspected or present, for example chorioamnionitis or prolonged rupture of membranes, treating the infection itself. This applies equally to native valve disease and prosthetic valves, which removes both option B and option C.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.