Peripartum cardiaomyopathy (PPCM): A 5 years experience at a tertiary centre

• Author Details:   
• Neelamma G Patil
• Rajasri G Yaliwal
• Shobha S Shiragur
• Sangamesh Sharanayya Mathapati
• Aruna Mallangouda Biradar ^*

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Background: In developed countries, maternal heart disease is one of the leading cause of maternal mortality, not only due to an increasing number of women with congenital heart disease (CHD) reach childbearing age but also because of the trend to delay motherhood until later in life, when medical comorbidities, such as chronic hypertension, diabetes, and obesity become more common. In low- to middle-income countries, common contributors to maternal death due to heart disease are typically rheumatic heart disease, cardiomyopathies such as peripartum cardiomyopathy, and uncorrected CHD. The purpose of this study is to identify the clinical risk factors associated with Peripartum Cardiomyopathy and the maternal and fetal outcomes in affected patients.

Materials and Methods: This is a 2 year prospective observational study conducted at a teaching institute and research center BLDE (DU) SHRI B.M. Patil Medical College Hospital and Research Center, Vijayapura from 1st Jan 2022 to 31st Dec 2023. All patients in their peripartum period diagnosed with cardiac failure by clinical and echocardiographic criteria were included in the trial. All the patient who were included underwent complete clinical examination and laboratory evaluation.

Results: A total of 35 women were diagnosed with Peripartum cardiomyopathy (PPCM) during the study period. It was mainly seen in patients between 35-37 weeks followed by 38-40 weeks. LSCS patients were more prone to Peripartum cardiac dysfunction than vaginal delivery patients. The ejection fraction was in the range of 36 - 40% in 37.1% of patients. However, mean EF was 35.94 ± 7.92. The most common risk factor was Eclampsia (40%) and second was post-partum hemorrhage leading to shock. The associated complications like Acute Renal Failure (ARF), Disseminated Intravascular Coagulation (DIC), HELLP syndrome, Thrombocytopenia were studied.

Conclusion: Eclampsia and postpartum hemorrhage are the leading contributors to the development of PPCM in this population. The findings underscore the importance of heightened surveillance in women with hypertensive disorders or significant obstetric complications. Early screening with echocardiography, particularly in high-risk pregnancies, can aid in prompt diagnosis and intervention. A multidisciplinary approach involving obstetricians, cardiologists, and intensivists is essential for improving maternal and fetal outcomes. Continued research and awareness are vital to developing region-specific protocols to reduce the burden of PPCM-related complications.