A woman with moderate rheumatic mitral stenosis is admitted in spontaneous labour at 38 weeks with intact membranes and no fever. Regarding prevention of infective endocarditis around delivery, the correct approach is:

• A Routine antibiotic prophylaxis is required for all women with structural heart disease during vaginal delivery
• B Single-dose amoxicillin is mandatory before artificial rupture of membranes
• C Prophylaxis is needed only for caesarean delivery performed electively
• D Antibiotic prophylaxis is not routinely indicated for uncomplicated vaginal delivery, but should be given if infection or suspected bacteraemia is present ✓

Explanation

Current AHA guidance does not recommend routine endocarditis prophylaxis for genitourinary or obstetric procedures in the absence of infection, because transient bacteraemia from labour alone is not sufficient justification. Prophylaxis is reserved for women with suspected bacteraemia, chorioamnionitis, or established infection, where therapeutic antibiotics are given anyway. Elective caesarean delivery likewise needs prophylaxis only for surgical wound reasons, not for endocarditis prevention.

Reference: Fernando Arias' Practical Guide to High-Risk Pregnancy and Delivery, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.