Endocardite infecciosa relacionada à gravidez / Infective Endocarditis in Pregnancy

PURPOSE--To report the intra-hospitalar and late follow-up of patients with infective endocarditis (IE) acquired in the pregnancy or puerperium. METHODS--Eleven patients, between 1984-1992 according to the beginning of the IE episode (fever and other signals) were studied. Patients were divided in two groups: IE of pregnancy (7 cases), and puerperal IE (4 cases). RESULTS--In the pregnancy IE group, mitral valve was affected in 6 (85), and aortic valve in 1 (15). During the course of the treatment, two patients had to be operated on, respectively, in the 24th and 28th week of the pregnancy. The 1st one had a successfully mitral valve replacement by a biological prosthesis but 48 h later she aborted, and the 2nd presented neurological complication (intracerebral hemorrhage) in the immediate post-operative period of a successfully mitral valve replacement by biological prosthesis. She was undergone to a cesarean but the fetus remained alive for 24 h only. If we look at the newborns (fetus), only 4 of them survived. Out of 3 fetal deaths, 2 had close association with mother cardiac surgeries. In the pregnant period acquired IE, 3 (47) mothers died. In the puerperium group, 2 mitral valves and 2 aortic valves had IE. Two of them had to be operated on due to an important aortic regurgitation and cardiac failure. There were no deaths in this group. CONCLUSION--During pregnancy, IE showed a high morbi-mortality for mother and concept. The mother's neurological complications played a major role in the poor outcome during the pregnancy period.

Histerectomia na infecçäo materna: quando indicar? / Hysterectomy in maternal infection: when to indicate?

Foram estudadas 18 pacientes histerectomizadas por infecçäo pós-aborto, parto prematuro ou no período puerperal. As pacientes foram divididas em três grupos de acordo com a gravidade do caso. Cerca de 38,9% das mesmas foram a óbito, o que demonstra a gravidade dos casos. Em 77,8%, as histerectomias foram indicadas pela infecçäo, e em 22,2% o fator determinante foi a hemorragia incontrolável, talvez devida à própria infecçäo (endomiometrite). Os autores ressaltam a dificuldade em determinar o momento exato de realizar a histerectomia. Houve associaçäo estatística entre anúria ou oligúria e a mortalidade materna, indicando um prognóstico sombrio para as pacientes levadas à cirurgia nesse estado. Portanto, a diurese foi o parâmetro que melhor se correlacionou com a mortalidade materna. A histerectomia deve ser indicada prontamente quando esse parâmetro se aproximar do limite de oligúria