Peripartum cardiomyopathy: risk factors, hospital course and prognosis; experiences at Lady Reading Hospital Peshawar

Abstract

To study the so-called risk factors associated with peripartum cardiomyopathy, its hospital course, short and long
term mortality and outcome of subsequent pregnancies. A total of 61 patients diagnosed with peripartum
cardiomyopathy were enrolled in the study. Data regarding risk factors, presenting complaints, complications,
pregnancy outcomes, therapeutics used and outcome at 3, 6 and 12 months were recorded. The incidence was
estimated to be 1 per 933 deliveries. Mean age ±SD was 30.94±6.63 years. Majority of patients 33(54.1%) were obese.
The mean parity was 3.66 ±1.41. Other risk factors were chronic hypertension 19 (31.1%), pre-eclampsia 12 (19.7%),
multiple pregnancies 5(8.2%), long term tocolysis 13 (21.3%) and anemia 21(34.4%). Forty-three patients 43(70.5%)
presented in post partum period while 18 (29.5%) in atepartum period. Majority of patients presented with dyspnea
and were in NYHA class ІІІ 18(29.5%) &IV 35(57.5%). Main ECG findings were sinus tachycardia 39 (63.9%), LV
hypertrophy 42 (68.9%), T wave inversion 28(45.9%) and Poor R wave progression in precordial leads with Q waves
40(65.6%). Ejection fraction was universally reduced. Other echocardiograpic findings included chamber dilation
48(78.7%), moderate to severe mitral regurgitation 15(24.6%), left ventricular thrombus 12 (19.7%) and pulmonary
artery hypertension 15(24.6%). Thirty-six women 36(59%) had normal vaginal delivery, 12(19.7%) had assisted vaginal
delivery and 13(21.3%) required caesarean section. There were 50(82%) live births and 11(18%) perinatal deaths. The
main complications were pulmonary edema 7(11.5%), cardiogenic shock 8(13.1%) and thromboembolism 13(21.3%).
At hospital discharge, 9 (14.8%) patients were dead and 52(85.2%) were discharged with stable heart failure. Major
therapeutics used was various drugs used in the treatment of heart failure and specialized therapies including
implantable cardiac defibrillator (ICD) 5(8.2%)), cardiac resynchronization therapy (CRT) 3(4.9%)) and cardiac
transplantation or left ventricular assist device 8(13.1%)). At the last follow up at month 12, total of 20(32.8%)) were
dead while 32(52.5%)) had recovered fully and 9(14.75%)) were still suffering from heart failure. During follow up, only
8 (19.5) pregnancies were detected. Five 5(62.5) patients had uneventful course while two 3(37.5) developed heart
failure again. Peripartum cardiomyopathy is associated with multiple risk factors and carries high morbidity and
mortality.