Endocarditis

Endocarditis in pregnancy is so rare that in 2008 the National Institute for Health and Care Excellence recommended that rou­tine prophylaxis not be given for any obstetric procedure (43, 44). However, some clinicians still prefer to give appropriate broad­spectrum antibiotic prophylaxis to women who have had previous endocarditis, or who have a mechanical valve.

Prosthetic heart valves

Women who need a heart valve replacement before pregnancy face a difficult choice. Replacement of a damaged valve with a homo- graft/xenograft has the major advantage that anticoagulation is not required because while it is still structurally intact, the valve func­tions in much the same way as a normal human valve. This makes