Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 14 , ISSUE 5 ( September-October, 2022 ) > List of Articles

ORIGINAL RESEARCH

Peripartum Cardiomyopathy: A Retrospective Study at a Tertiary Care Center

Shweta Avinash Khade, Snehal Shivaji Shinde, Eshita Davinder Wadhwa, Smurti Gorakhnath Kamble, Archana Anilkumar Bhosale, Arun Harishchandra Nayak

Keywords : Cardiovascular collapse, Cardiac disease in pregnancy, Heart failure, High-risk pregnancy, Maternal mortality, Obstetric outcomes

Citation Information : Khade SA, Shinde SS, Wadhwa ED, Kamble SG, Bhosale AA, Nayak AH. Peripartum Cardiomyopathy: A Retrospective Study at a Tertiary Care Center. J South Asian Feder Obs Gynae 2022; 14 (5):583-586.

DOI: 10.5005/jp-journals-10006-2110

License: CC BY-NC 4.0

Published Online: 16-11-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aims and objectives: To study associated risk factors, a clinical pattern of presentation, course of the disease, and outcome in Peripartum cardiomyopathy (PPCM) cases. Materials and methods: A retrospective observational study of cases diagnosed with peripartum cardiomyopathy was conducted at the Department of Obstetrics and Gynecology, LTMMC, Mumbai, for a duration of 2 years (from January 2020 to December 2021). Results: Out of a total of 12,880 delivered patients in 2 years, 9 (0.07%) cases were diagnosed and managed as PPCM. Our study revealed that PPCM was common in young patients in the age group 21–30 years. About 5 (55.6%) were primigravidas and 4 were (44.4%) multigravidas. In our study, 56% of cases presented antenatally and 44% postnatally. The majority of study participants had NYHA grade III breathlessness. Cardiogenic shock in the form of the postpartum collapse was noted in a single case. Preeclampsia was the most common obstetric comorbidity noted in 66% of cases. Medical comorbidity in the form of type-1 diabetes mellitus (DM) was present in 11% of cases and chronic hypertension in 22% of cases. Mean ejection fraction was 34% on 2D echo. No thromboembolic event was noted in any case. Maternal mortality was seen in 2/9 (22%) cases. Conclusion: The majority of the study participants were young primigravidas with preeclampsia being a strongly associated risk factor. Early signs and symptoms of heart failure can be obscured by physiological hemodynamic changes in pregnancy. A high index of suspicion is thus essential for early diagnosis and timely intervention, which is the key measure for a favorable outcome.


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  1. Prasad GS, Bhupali A, Prasad S, et al. Peripartum cardiomyopathy – Case series. Indian Heart J 2014;66(2):223–226. DOI: 10.1016/j.ihj.2014.02.007.
  2. Pandit V, Shetty S, Kumar A, et al. Incidence and outcome of peripartum cardiomyopathy from a tertiary hospital in South India. Trop Doct 2009;39(3):168–169. DOI: 10.1258/td.2008.080353.
  3. Patten IS, Rana S, Shahul S, et al. Cardiac angiogenic imbalance leads to peripartum cardiomyopathy. Nature 2012;485(7389):333–338. DOI: 10.1038/nature11040.
  4. De Rosa S, Eposito F, Carella C, et al. Transcoronary concentration gradients of circulating microRNAs in heart failure. Eur J Heart Fail 2018;20(6):1000–1010. DOI: 10.1002/ejhf.1119.
  5. Pearson GD, Veille JC, Rahimtoola S, et al. Peripartum cardiomyopathy. National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. J Am Med Assoc 2000;283(9):1183–1188. DOI: 10.1001/jama.283.9.1183.
  6. Isogai T, Kamiya CA. Worldwide incidence of peripartum cardiomyopathy and overall maternal mortality. Int Heart J 2019;60(3):503–511. DOI: 10.1536/ihj.18-729.
  7. Davis M, Duvernoy C. Peripartum cardiomyopathy: Current knowledge and future directions. Womens Health (Lond) 2015;11(4):565–573. DOI: 10.2217/whe.15.15.
  8. Demakis JG, Rahimtoola SH, Sutton GC, et al. Natural course of peripartum cardiomyopathy. Circulation 1971;44(6):1053–1061. DOI: 10.1161/01.cir.44.6.1053.
  9. Fett JD, Christie LG, Carraway RD, et al. Five-year prospective study of the incidence and prognosis of peripartum cardiomyopathy at a single institution. Mayo Clin Proc 2005;80(12):1602–1606. DOI: 10.4065/80.12.1602.
  10. Sliwa K, Fett J, Elkayam U. Peripartum cardiomyopathy. Lancet 2006;368(9536):687–693. DOI: 10.1016/S0140-6736(06)69253-2.
  11. Agarwal R, Baid R, Sinha DP. Peripartum cardiomyopathy in Indian population: A pooled analysis. J Clin Prev Cardiol 2021;10(2):54–57. DOI: 10.4103/jcpc.jcpc_61_20.
  12. Bello N, Rendon ISH, Arany Z. The relationship between pre-eclampsia and peripartum cardiomyopathy: A systematic review and meta-analysis. J Am Coll Cardiol 2013;62(18):1715–1723. DOI: 10.1016/j.jacc.2013.08.717.
  13. Sliwa K, Mebazaa A, Hilfiker-Kleiner D, et al. Clinical characteristics of patients from the worldwide registry on peripartum cardiomyopathy (PPCM). EURObservational Research Programme in conjunction with the Heart Failure Association of the European Society of Cardiology Study Group on PPCM. Eur J Heart Fail 2017;19(9):1131–1141. DOI: 10.1002/ejhf.780.
  14. Binu AJ, Rajan SJ, Rathore S, et al. Peripartum cardiomyopathy: An analysis of clinical profiles and outcomes from a tertiary care centre in southern India. Obstet Med 2020;13(4):179–184. DOI: 10.1177/1753495X19851397.
  15. Kerpen K, Koutrolou-Sotiropoulou P, Zhu C, et al. Disparities in death rates in women with peripartum cardiomyopathy between advanced and developing countries: A systematic review and meta-analysis. Arch Cardiovasc Dis 2019;112(3):187–198. DOI: 10.1016/j.acvd.2018.10.002.
  16. Hilfiker-Kleiner D, Haghikia A, Berliner D, et al. Bromocriptine for the treatment of peripartum cardiomyopathy: A multicentre randomized study. Eur Heart J 2017;38(35):2671–2679. DOI: 10.1093/eurheartj/ehx355.
  17. Sliwa K, Skudicky D, Candy G, et al. The addition of pentoxifylline to conventional therapy improves outcome in patients with peripartum cardiomyopathy. Eur J Heart Fail 2002;4(3):305–309. DOI: 10.1016/s1388-9842(02)00008-9.
  18. Bonow RO, Mann DL, Zippes DP, et al. Braunwald's Heart Disease, Textbook of Cardiovascular Medicine. 9th ed. 2010:1776–1777.
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