Peripartum cardiomyopathy complicating major postpartum haemorrhage with pre-eclampsia and HELLP syndrome
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20264015Keywords:
Peripartum cardiomyopathy, HELLP syndrome, Pre-eclampsia, Postpartum haemorrhageAbstract
Peripartum Cardiomyopathy (PPCM) is a rare, potentially life-threatening cause of heart failure, developing in the later stages of pregnancy, or immediately postpartum. Diagnosis can become challenging as obstetric emergencies may provide differing explanations for cardiovascular collapse. We demonstrate a rare case of acute severe biventricular failure occurring very soon after an emergency Caesarean section for a pregnancy complicated by HELLP syndrome in the setting of post-partum pre-eclampsia and severe postpartum haemorrhage. The diagnostic value of an urgent echocardiogram in an obstetric emergency is underlined and the challenges faced by clinicians in managing two serious medical emergencies at the same time are highlighted.
References
MBRRACE-UK. Maternal mortality 2022–2024. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2026, Available at: https://www.npeu.ox.ac.uk/mbrrace-uk/data-brief/maternal-mortality-2022-2024,Accessed on 23 September 2026
Bauersachs J, König T, van der Meer P, Petrie MC, Hilfiker-Kleiner D, Mbakwem A, et al. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail. 2019;21(7):827-43.
De Backer J, Haugaa KH, Hasselberg NE, de Hosson M, Brida M, Castelletti S, et al. 2025 ESC Guidelines for the management of cardiovascular disease and pregnancy. Eur Heart J. 2025;46(43):4462-568.
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-241.
Sliwa K, Mebazaa A, Hilfiker-Kleiner D, Petrie MC, Maggioni AP, Laroche C, et al. Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy: EURObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail. 2017;19(9):1131-41.
Blauwet LA, Libhaber E, Forster O, Tibazarwa K, Mebazaa A, Hilfiker-Kleiner D, et al. Predictors of outcome in 176 South African patients with peripartum cardiomyopathy. Heart. 2013;99(5):308-13.
Ghadri JR, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ, et al. International expert consensus document on Takotsubo syndrome (part I): clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J. 2018;39(22):2032-46.
Arany Z, Elkayam U. Peripartum cardiomyopathy. Circulation. 2016;133(14):1397-409.
National Institute for Health and Care Excellence. Hypertension in pregnancy: diagnosis and management. NICE guideline NG133, London: NICE; 2019 Available at: https://www.nice.org.uk/guidance/ng133. Accessed on 23 September 2026
McNamara DM, Elkayam U, Alharethi R, Damp J, Hsich E, Ewald G, et al. Clinical outcomes for peripartum cardiomyopathy in North America: results of the IPAC Study. J Am Coll Cardiol. 2015;66(8):905-14.
Schelbert EB, Elkayam U, Cooper LT, Givertz MM, Alexis JD, Briller J, et al. Myocardial damage detected by late gadolinium enhancement cardiac magnetic resonance is uncommon in peripartum cardiomyopathy. J Am Heart Assoc. 2017;6(4):e005472.
Bauersachs J, Arrigo M, Hilfiker-Kleiner D, Veltmann C, Coats AJS, Crespo-Leiro MG, et al. Current management of patients with severe acute peripartum cardiomyopathy: practical guidance from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail. 2016;18(9):1096-105.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ahmed Ali Kindawi, Shamma Al-Inizi

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.