Abstract :Background: Infective endocarditis in pregnancy is a rare but severe clinical condition, both for
the mother and the foetus. Symptoms may be misleading due to their confusion with the expected
effects of pregnancy.
Case Presentation: A 37-year-old woman, gravida 7 para 2, pregnant at 17 weeks of gestation was
diagnosed with an infective endocarditis caused by streptococcus mitis after a persistent inflammatory
syndrome with dry cough. Echocardiography confirmed mitral endocarditis after positive blood
cultures, showing a moderate mitral insufficiency with vegetations. At 17 weeks of gestation, the
patient underwent cardiac surgery under cardiopulmonary bypass. A successful mitral replacement
was carried out without complications. At 22 weeks of gestation, ultrasound demonstrated a major
cerebral malformation with hydrocephaly, and abnormal kidneys differentiation. After premature
rupture of the membranes at 31 weeks and three days with antibiotics, the patient delivered a girl of
1840 grams, with an Apgar score of 9-8-8. The clinical exam of the baby showed a macrocephaly and
a setting-sun sign. The baby died a few hours after delivery.
Conclusion: Treatment of infective endocarditis in pregnancy poses a dilemma due to the balance
of risks for the mother and the foetus. As illustrated by our case, when endocarditis occurs early
in the pregnancy, the necessary cardiac surgery requires the adoption of specific precautions.
Despite these precautions allowing the foetus to survive surgery, severe malformations may lead to
newborn’s early death.