Peripartum Cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a rare but potentially lethal complication of pregnancy occurring in approximately 1in 3000 live births in the United States although some series report a much higher incidence. African-American women are particularly at risk. Diagnosis requires symptoms of heart failure in the last month of pregnancy or within five months of delivery in the absence of recognized cardiac disease prior to pregnancy as well as objective evidence of left ventricular systolic dysfunction. Obstetricians should suspect the diagnosis, particularly if the patient has risk factors. Evaluation should include an echocardiogram to assess the LV systolic function. Treatment includes ACE inhibitors or angiotensin receptor blockers, beta-blockers, and diuretics. Consideration should be given to anticoagulation. A number of causes are being investigated, including nutritional, infectious, and genetic, which, hopefully, lead to more targeted treatments. This paper provides an updated, comprehensive review of PPCM, including emerging insights into the etiology of this disorder as well as current treatment options. Designation Definition The research definition of peripartum cardiomyopathy has four criteria. The patient must develop cardiac failure, specifically dilated cardiomyopathy, due to decreased systolic dysfunction of the left ventricle in the last month of pregnancy or within five months of delivery. There must be an absence of an identifiable cause for the cardiac failure. There must be an absence of recognizable heart disease prior to the last month of pregnancy. Additionally, left ventricular systolic dysfunction should be demonstrated by classic echocardiography criteria, such as depressed shortening fraction (less than 30 percent) or decreased ejection fraction (less than 45 percent) 10,11,12. Risk Factors and Etiology Risk factors for peripartum cardiomyopathy include obesity1, previous peripartum cardiomyo-pathy, multiparity, advanced maternal age, multifetal pregnancy, gestational hypertension, preeclampsia, use of tocolytics, and African-American race13,14,15,16,17. An exact cause of peripartum cardiomyopathy has yet to be identified13,14. The hypothetical causes of peripartum cardiomyopathy include myocarditis, a maladaptive response to the hemodynamic stresses of pregnancy, hypertension, an abnormal immune response to pregnancy, stress-activated inflammatory Bangladesh J Obstet Gynaecol, 2009; Vol. 24(2) : 67-70