Peripartum cardiomyopathy in preeclampsia with severe features and eclampsia: a prospective observational study from a tertiary care center

Abstract

Background: Hypertensive disorders of pregnancy remain a major cause of maternal morbidity and mortality worldwide. Cardiovascular involvement is increasingly recognized as an important determinant of disease severity and maternal outcome. The present study evaluated the clinical presentation, echocardiographic characteristics, management strategies, and maternal outcomes of peripartum cardiomyopathy in patients with preeclampsia with severe features and eclampsia.

Methods: A prospective observational study was conducted at a tertiary care center from January 2025 to December 2025. Pregnant and postpartum women with preeclampsia with severe features or eclampsia presenting with newly detected left ventricular systolic dysfunction suggestive of peripartum cardiomyopathy were included. Clinical, echocardiographic, management, and outcome data were analyzed.

Results: The mean age was 27.3±5.8 years. The overall incidence of peripartum cardiomyopathy was 0.24% among total deliveries. Cardiac dysfunction occurred in 5% of patients with preeclampsia with severe features and 20% of patients with eclampsia. No mortality was observed among patients with LVEF ≥30%, whereas mortality occurred in patients with very severe systolic dysfunction (LVEF <30%). A progressive increase in case detection was observed over time.

Conclusions: Peripartum cardiomyopathy associated with preeclampsia with severe features and eclampsia represents a serious complication with significant prognostic implications. Very severe left ventricular systolic dysfunction (LVEF <30%) is a strong predictor of maternal mortality. Early echocardiographic evaluation and multidisciplinary management are essential for improving maternal outcomes.