3) A 22-year-old
primigravid woman comes to the labor and delivery ward at term with regular,
painful contractions. Her prenatal course was unremarkable. She has a past
medical history significant for mitral valve prolapse with regurgitation
demonstrated on echocardiography. She takes no medications and has no allergies
to medications. Examination shows that her cervix is 4 centimeters dilated and
the fetus is in vertex presentation. The fetal heart rate is reassuring. Which
of the following is the most appropriate management of this patient?
A. Administer intravenous antibiotics throughout labor.
B. Administer intravenous antibiotics 30 minutes prior to the delivery.
C. Administer intravenous antibiotics after the cord is clamped.
D. Administer intravenous antibiotics six hours after the delivery.
E. Antibiotic prophylaxis is not necessary
Explanation:
The correct answer is
E. Bacterial endocarditis is a potentially life-threatening infection that can develop in patients with structural cardiac disease who are exposed to bacteremia. The risk of developing endocarditis depends upon both the cardiac condition and the nature of the procedure. The American Heart Association periodically 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 include 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. To administer intravenous antibiotics throughout labor (choice A), to administer intravenous antibiotics 30 minutes prior to the delivery (choice B), to administer intravenous antibiotics after the cord is clamped (choice C), or to administer intravenous antibiotics six hours after the delivery (choice D) would not be necessary. As explained above, mitral valve prolapse with regurgitation is considered to be a moderate risk condition and, for these conditions, antibiotic prophylaxis to prevent bacterial endocarditis is not necessary.
A. Administer intravenous antibiotics throughout labor.
B. Administer intravenous antibiotics 30 minutes prior to the delivery.
C. Administer intravenous antibiotics after the cord is clamped.
D. Administer intravenous antibiotics six hours after the delivery.
E. Antibiotic prophylaxis is not necessary
Explanation:
The correct answer is
E. Bacterial endocarditis is a potentially life-threatening infection that can develop in patients with structural cardiac disease who are exposed to bacteremia. The risk of developing endocarditis depends upon both the cardiac condition and the nature of the procedure. The American Heart Association periodically 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 include 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. To administer intravenous antibiotics throughout labor (choice A), to administer intravenous antibiotics 30 minutes prior to the delivery (choice B), to administer intravenous antibiotics after the cord is clamped (choice C), or to administer intravenous antibiotics six hours after the delivery (choice D) would not be necessary. As explained above, mitral valve prolapse with regurgitation is considered to be a moderate risk condition and, for these conditions, antibiotic prophylaxis to prevent bacterial endocarditis is not necessary.
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