Peripartum cardiomyopathy presenting to cardiology department of Mayo Hospital, Lahore

Abstract

Cardiac failure occurring in last trimester of pregnancy or within one to six months after delivery in a woman without a history of heart disease and with no cause for heart failure other than pregnancy is termed as peripartum cardiomyopathy. To determine fetomaternal morbidity and mortality in women presenting with peripartum cardiomyopathy, we did an open non-randomized observational descriptive study at Department of Cardiology Mayo Hospital, Lahore from January 2004 to Oct 2005. The women referred from Lady Willingdon and Lady Aitchison Hospitals to Cardiology Department of Mayo Hospital during last trimester and after delivery for work up of heart failure were included. Twenty five women presented with heart failure due to peripartum cardiomyopathy were included in this study, 40% in last trimester, 40% within one month and 20% within 4 month after delivery. The mean age was 35 + 5 years. Out of these 2 (8%) were primiparous, 13 (52%) were multiparous and 10 (40%) were grandmultipara. Ten (40%) were booked and 15 (60%) were nonbooked for antenatal care. Twenty (40%) patients were diagnosed for the first time and 5 (20%) had recurrence. Based on NYHA classification 20% were in class I, 40% class II, 20% class III and 20% in class IV. The patients were on standard medical treatment. All patients reviewed at follow up after 1, 6, and 12 months. No maternal mortality occurred. Antenatal ward admission was required for 32% women due to obstetric reasons and 8% due to cardiac cause. Five had spontaneous labor and 5 inductions were done for obstetric reasons: poor biophysical profile, previous caesarean section, uncontrolled diabetes, breech presentation and fetal distress. Three babies have intrauterine growth retardation. On echocardiography mean ejection fraction was 20-25% with global hypokinesia, 5 patients had clot in LV apex, 10 had whiff of mitral regurgitation and tricuspid regurgitation. We conclude that peripartum cardiomyopathy has high morbidity and mortality. Women are very much receptive about c ontraception in the immediate post partum period, therefore counseling of the patient and their family should be done to reduce maternal mortality.