Saving Mothers' Lives: - Public Health Agency for Northern Ireland

Infectious endocarditis
Two women died from infectious endocarditis, both of which involved the mitral valve. One was in a
mechanical valve replacement and the other in a woman who was known to be a substance abuser:
A young, excluded woman on a methadone maintenance programme booked early in her
pregnancy but from then on was diffi cult to contact. She had a history of abscesses and deep
vein thrombosis (DVT) related to injecting and although she was supposed to be on long term
warfarin she had discontinued this. Late in her second trimester she felt generally unwell, which
persisted for two weeks before her death. Several days prior to her death she was feeling hot and
cold with abdominal pain and vomiting. In retrospect these were the symptoms of endocarditis/
bacteraemia. She had also stopped antibiotics prescribed by the GP.
Her care cannot be classifi ed as sub-standard even though it was only at autopsy that vegetations on the mitral
valve and focal suppurative myocarditis were discovered. She also had infective thrombi in her kidneys and
the organisms seen in other organs suggested an overwhelming bacteraemia. Although toxicology revealed
therapeutic methadone, recent cocaine and very recent heroin, which also might have contributed to her death,
she died of endocarditis and bacteraemia. Her attendance at the GP’s surgery was a rare opportunity to treat
her, but even if admission to hospital had been suggested she may well have declined. although theoretically
intravenous antibiotics at this stage may have saved her. Her specialist midwives are to be congratulated for the
efforts they made to contact her as the rare contacts she did have with them must have taken great persistence.
Sudden adult death syndrome (SADS)
SADS is defi ned as sudden death in an adult for which no cause can be found. Three mothers died of SADS
during this triennium compared to two in the last Report. They all died before delivery, two in mid pregnancy and
one at term. There were nine further Late deaths where no cause of death was found and these were therefore
also classifi ed as SADS. Of these twelve women, fi ve were overweight or obese.
A French study 9 has demonstrated that circulating non-esterifi ed fatty acid concentration is an independent risk
factor for sudden death in middle-aged men. Hence, obesity may be relevant. A more recent study 10 has identifi ed
an inherited disease and likely cause of death in 17 of 43 families (40%) with one or more relatives aged 40 years
or more with a history of sudden death. There is therefore a need to counsel family members of the possibility of a
genetic component for this condition.
Acknowledgements
This Chapter has been seen and discussed with Dr Sara Thorne, Consultant Cardiologist, Birmingham.
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