DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20171425

Peri-partum cardiomayopathy-not a rare entity, clinical profile in a rural tertiary care center in Gujarat, India

Rumi Bhattacharjee, Nitin Raithata, Molina Patel, Smruti Vaishnav

Abstract


Background: Peri-partum cardiomayopathy (PPCM) in pregnancy has a potential to adversely affect both mother and fetus. Severe cases can be associated with life threatening complications unless managed promptly by multidisciplinary team. The objective was to study maternal and fetal outcome of PPCM patients.

Methods: An observational cohort over 4 years (2012 to 2015) was conducted in a Rural tertiary care center. Consecutive antenatal and postpartum women with PPCM were studied for medical and obstetric complications, deliveries, fetal outcome and maternal mortality.

Results: The incidence of PPCM was 0.3% and Most patients presented with typical signs and symptoms of heart failure. 55.5% were in NYHA 3 and 4 and 50% had ejection fraction below 30%. 83.3% required ICU admissions of varying length and Maternal mortality was in 1 patient (5.56%). PPCM occurred in 55.5% of ante partum against 44.4% of postpartum patients. Obstetric complications like PPH occurred in 11.1% while poor fetal outcome like preterm deliveries occurred in 50% while still births in 16.67%.

Conclusions: The low incidence and rarity of PPCM presents itself with diagnostic dilemma. Obstetrician should have high index of suspicion in patients with heart failure and high risk factors. Early diagnosis and prompt treatment can only improve the outcome.


Keywords


Cardiomyopathy distress, Peri-partum cardiomayopathy

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References


Lata I, Gupta R, Sahu S, Singh H.; Emergency management of decompensate peripartum cardiomyopathy. J Emerg Trauma Shock. 2009;2:124-8.

Demakis JG, Rahimtoola SH, Sutton GC, Meadws WR, Szanto PB, Tobin JR et al. Natural course of peripartum cardiomyopathy. Circulation. 1971;44:1053-61.

Demakis JG, Rahimtoola SH, Sutton GC, Meadows WR, Szanto PB, Tobin JR, Gunnar RM. Natural course of peripartum cardiomyopathy. Circulation. 1971;44(6):1053-61.

Fett JD, Christie LG. Unrecognized peripartum cardiomyopathy in Haitian women. Int J Gynaecol Obstet. 2005;90(2):161-6.

Fisher, S., Etherington, A. Peripartum cardiomyopathy: An update. Progr Ped Cardiol. 2008;25(1):79-84.

Ritchie, C. Clinical contribution to the pathology, diagnosis and treatment of certainchronic diseases in the heart. Edinburgh Med Surg. 1849;2:333.

Viviana Aursulesei and Mihai Dan Datcu Peripartum Cardiomyopathy: A Systematic Review University of Medicine and Pharmacy “Gr. T. Popa”, Iasi Romania

Mielniczuk L.M. Frequency of peripartum cardiomyopathy. Am J Cardiol. 2006;97(12)1765-1768.

Sanderson JE, Adesanya CO, Anjorin FI et al. Postpartum cardiac failure-heart failure due to volume overload? Am Heart J. 1979;97:613-21.

Pandit V, Shetty S, Kumar A . Incidence and outcome of peripartum cardiomyopathy from a tertiary hospital in South India. Trop Doct. 2009;39(3):168-9.

Murali, S, Baldisseri, MR. (2005). Peripartum cardiomyopathy. Crit Care Med. 2005;33(10):340-6,

Hilfiker-Kleiner D, Meyer GP, Schieffer E, Goldmann B, Podewski E, Struman I, Fischer P, Drexler H. Recovery from postpartum cardiomyopathy in 2 patients by blocking prolactin release with bromocriptine. Journal of the American College of Cardiology. 2007;50(24):2354-5.

Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, Ansari A, Baughman KL. Peripartum cardiomyopathy: national heart, lung, and blood institute and office of rare diseases (national institutes of health) workshop recommendations and review. Jama. 2000;283(9):1183-8.

Sliwa K, Förster O, Libhaber E, Fett JD, Sundstrom JB, Hilfiker-Kleiner D, Ansari AA. Peripartum cardiomyopathy: inflammatory markers as predictors of outcome in 100 prospectively studied patients. European heart journal. 2006 ;27(4):441-6.

Ansari AA, Fett JD, Carraway RE, Mayne AE, Onlamoon N, Sundstrom JB. Autoimmune mechanisms as the basis for human peripartum cardiomyopathy. Clinical reviews in allergy and immunology. 2002;23(3):301.

Elkayam U, Akhter MW, Singh H, Khan S, Bitar F, Hameed A, Shotan A. Pregnancy-associated cardiomyopathy. Circulation. 2005 Apr 26;111(16):2050-5.

Bertrand, E. La myocardiopathie du post-partum: à propos de cas. Arch Mal Coeur Vaiss. 1997;70(2):169-78.

Cole WC, Mehta JB, Roy TM, Downs CJ. Peripartum cardiomyopathy: echocardiogram to predict prognosis. Tennessee medicine: journal of the Tennessee Medical Association. 2001;94(4):135.

Bennani SL, Loubaris M, Lahlou I, Haddour N, Badidi M, Bouhouch R, Cherti M, Arharbi M. Postpartum cardiomyopathy revealed by acute lower limb ischemia. InAnnales de cardiologie et d'angeiologie 2003;52(6):382-85.

Sliwa, Karen, et al. "Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy." European journal of heart failure. (2010):767-78.

Elkayam, U, Goland, S Bromocriptine for the treatment of peripartum cardiomyopathy. Circulation. 2010;121(13):1463-4,

Hilfiker-Kleiner D, Sliwa K, Drexler H. Peripartum cardiomyopathy: recent insights in its pathophysiology. Trends in cardiovascular medicine. 2008;18(5):173-9.

Veille JC. Peripartum cardiomyopathies: a review.Am J Obstet Gynecol. 1984;148:805-18.

Fett JD, Christie LG, Murphy JG. Brief communication: Outcomes of sub- sequent pregnancy after peripartum cardiomyopathy: a case series from Haiti. Ann Intern Med. 2006;145:30-4.