Prophylaxis against infective endocarditis in obstetrics: new NICE guidance: a commentary

Infective endocarditis in pregnant women

“…Несмотря на редкость заболевания и недостаток до-казательств эффективности антибактериальной терапии для предупреждения эндокардита в акушерско-гинеколо-гической практике, считается оправданным назначение АБ с профилактической целью, особенно женщинам, имеющим «поражения высокого риска» [81,82]. Хотя На-циональное руководство для Англии и Уэльса NICE [83] не рекомендует назначение АБ даже больным из группы высокого риска, подвергающимся стоматологическим процедурам, для минимизации вероятности развития ана-филактических реакций и резистентности микрофлоры к АБ.…”

Aseptic precautions for epidural blood patch

“…Presumably the bacterial filter had to be removed before injecting the blood, so I wonder if the authors could eludicate how they ensured meticulous asepsis of the epidural catheter hub before connecting the syringe? Secondly, women who have recently delivered vaginally may have bacteraemia [3], and meningitis has been reported previously as a complication of epidural blood patch [4]. What measures did the authors take before the blood patch to assess patients for bacteraemia or sepsis?…”

Accidental dural puncture: patch or wait?

“…I noticed that the range of times between accidental dural puncture and administration of the prophylactic epidural blood patch varied from 5 h to 30 h. As postdural puncture headache (PDPH) can occur almost instantaneously [2], with symptoms beginning before 48 h in 66% of cases [3], I wondered if the authors could clarify whether any symptoms of PDPH had occurred in the patients who received their treatment towards 30 h after accidental dural puncture, effectively re-classifying their blood patch as therapeutic rather than prophylactic? The randomised controlled trial of prophylactic versus therapeutic blood patching following accidental dural puncture by Stein et al [1] is a useful addition to the literature on this subject.…”