Definition
If any patient develops cardiac failure in the 3rd trimester of pregnancy or within 6 months after delivery in the absence of previous heart disease, it is called postpartum or peripartum cardiomyopathy.
It is a type of dilated cardiomyopathy and the cause is unknown. Immune and viral causes are postulated. Other factors are advanced age, multiple pregnancy, multiparity and hypertension in pregnancy. Commonly occurs immediately after or in the month before delivery (peripartum).
Symptoms
It occurs usually in multipara, age above 30 years.
• Respiratory distress, orthopnea.
• Features of heart failure—weakness, pain in the abdomen, swelling in legs.
• Cough with frothy sputum due to pulmonary edema.
Signs
• Signs of heart failure.
• Atrial fibrillation or other arrhythmias may occur.
Diagnostic Criteria (four criteria)
1. Presentation in the last month of pregnancy or within 6 months of delivery.
2. Absence of an obvious cause for heart failure.
3. Previously normal cardiac status.
4. Echocardiographic evidence of systolic left ventricular dysfunction.
Treatment
• Symptomatic for heart failure (diuretics, ACE inhibitor, digoxin).
• Beta-blocker may be helpful in some cases.
• Inotropic agent may be given.
Prognosis
More than half of cases have a complete or near complete recovery over several months. Immunosuppressive therapy has doubtful value. Mortality rate is 10 to 20%.
The patient should avoid subsequent pregnancy, due to risk of relapse. However, if the heart
size is normal in the first episode following heart failure, subsequent pregnancy is tolerated in
some cases. If the heart size remains enlarged, further pregnancy causes refractory chronic heart failure.