ARJ
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A 32-year-old woman comes to the hospital for an elective repeat cesarean delivery. Four years ago she had a primary cesarean delivery for a nonreassuring fetal heart rate tracing. Two years ago she chose to have an elective repeat cesarean delivery rather than attempt a vaginal birth after cesarean (VBAC). Her prenatal course was uncomplicated except that she has mitral valve prolapse. An echocardiograph demonstrated the mitral valve prolapse, but no other structural cardiac disease. Which of the following is the correct management of this patient?
a) Administer intravenous antibiotics 30 minutes prior to the procedure
b)Administer intravenous antibiotics immediately after the procedure
c)Administer intravenous antibiotics for 24 hours after the procedure
d)Administer oral antibiotics 6 hours after the procedure
e)No antibiotics are needed
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| catmd
Forum Senior
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E.
Valve Insufficiencies apparently do better in pregnancy bcos of incr CO and decr SVR so pt would not be at risk?
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| phuluong2k
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E
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| nisha
lil monkey
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E, only need prophylaxis if it has developed an accompanied murmure of MR
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| ARJ
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e)No antibiotics are needed
Mitral valve prolapse affects approximately 5% of women of childbearing age. Consequently, the issue of mitral valve prolapse and the need for antibiotics comes up quite often in obstetrics, particularly with delivery (either vaginal delivery or cesarean delivery). Bacterial endocarditis is a life-threatening infection that can develop in patients with structural cardiac disease who are exposed to bacteremia. The risk for any given procedure depends upon the nature of the procedure itself and on the nature of the cardiac lesion. Periodically, the American Heart Association publishes guidelines for the prevention of bacterial endocarditis. According to the American Heart Association guidelines, antibiotic prophylaxis is not necessary for cesarean delivery or normal vaginal delivery. The possible exception to this is for patients with "high risk" cardiac conditions, which includes women with a history of endocarditis or who have prosthetic heart valves, complex cyanotic congenital heart disease, or surgically corrected systemic pulmonary shunts. Mitral valve prolapse, if associated with mitral regurgitation (demonstrated by Doppler or a murmur), is considered a moderate risk condition and, therefore, antibiotic prophylaxis is not necessary. This patient, therefore, does not require antibiotics prior to, during, or after her cesarean delivery. To administer intravenous antibiotics 30 minutes prior to the procedure (choice A), immediately after the procedure (choice B), 24 hours after the procedure (choice C), or to administer oral antibiotics 6 hours after the procedure (choice D) would all be unnecessary. As explained above, the reason for administering antibiotics to women with structural cardiac disease is to prevent bacterial endocarditis. Bacterial endocarditis is a potentially fatal condition. However, there are different degrees of structural cardiac disease. Mitral valve prolapse with regurgitation is considered to be a moderate risk condition. The American Heart Association does not recommend endocarditis prophylaxis for women with moderate risk conditions undergoing vaginal or cesarean delivery.
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"Live as if you were to die tomorrow. Learn as if you were to live forever." --Mahatma Gandhi
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