RESUMEN
Worldwide about 287,000 maternal deaths occur every year, and significant variation exists between low/high/middle-income populations.[1] Maternal death has direct and indirect causes. Indirect maternal deaths result from conditions existing before maternity or recently developed not related to maternity, e.g. cardiovascular diseases, HIV/AIDS, anaemia, infections. World Health Organization (WHO) outlined it as a condition within which “a woman nearly died, however survived throughout pregnancy, childbirth or within 42 days of termination of pregnancy, just by a chance or good hospital care.”[2] Heart conditions presently represent the most common reason behind indirect maternal obstetrics deaths. Pregnancy is related to substantial and progressive hemodynamic changes beginning early in maternity, reaching their peak at the end of 2nd trimester and remaining comparatively constant till child-birth. Major alterations in maternity include a 30 to 50 percent increase in blood volume and cardiac output and decreased blood pressure. In cardiac pregnant patients, these modifications might cause clinical decompensation, exposing these patients to probably life-threatening situations.[3] Here we represent a similar case of a maternal near miss due to severe cardiac dysfunction reported at 8 months amenorrhea.
RESUMEN
In patients of infective endocarditis, aortic valve is most commonly involved followed by the mitral valve. Pulmonary and tricuspid valves are the least involved valves. Multiple valves can also be involved and are seen in 17-22% cases.[1] Right sided infective endocarditis is seen in approximately 10% of the total cases.[2] Isolated tricuspid valve prevalence has been reported in the range of 2.5–3.1 % and isolated pulmonary valve involvement has been reported to be 2%.[3,4] Tricuspid valve (TV) endocarditis commonly occurs in intravenous drug users (IVDU) or any abnormality of the TV. The other causes could be, patients with implantable cardiac defibrillators (ICD), central venous catheter or right sided cardiac anomalies.[5] We report a case of a previously healthy young woman, who was neither an intravenous (IV) drug user nor had any congenital heart disease, who developed TV endocarditis after an induced abortion. This case exemplifies the need for strong suspicion for right-sided IE in patients presenting with pyrexia of unknown origin (PUO) or cardiorespiratory symptoms after gynaecological interventions.