PERIPARTUM CARDIOMYOPATHY: RISK FACTORS, HOSPITAL COURSE AND PROGNOSIS; EXPERIENCES AT LADY READING HOSPITAL PESHAWAR

Abstract

Objective: To study the so-called risk factors associated with peripartum
cardiomyopathy (PPCM), its hospital course, short and long term mortality and
outcome of subsequent pregnancies. Methodology: A total of 61 patients diagnosed with PPCM were enrolled in the study. Data regarding risk factors, presenting complaints, complications, pregnancy outcomes, therapeutics used and outcome at 3, 6 and 12 months were recorded.

Results: The incidence was estimated to be 1 per 933 deliveries. Mean age±SD
was 30.94±6.63 years. Majority of patients 33(54.1%) were obese. The mean
parity was 3.66 ±1.41. Other risk factors were chronic hypertension 19
(31.1%), pre-eclampsia 12 (19.7%) and multiple pregnancies 5(8.2%).
Forty-three patients 43(70.5%) presented in post partum period while 18
(29.5%) in antepartum period. All patients presented with dyspnea. Main ECG
findings were sinus tachycardia 39 (63.9%), LV hypertrophy 42 (68.9%) and T
wave inversion 28(45.9%). Ejection fraction was universally reduced on
echocardiography. There were 50(82%) live births and 11(18%) perinatal deaths. Main complications were pulmonary edema 7(11.5%), cardiogenic shock
8(13.1%) and thromboembolism 13(21.3%). At hospital discharge, 9 (14.8%)
patients were dead and 52(85.2%) were discharged with stable heart failure. At
th 12 month follow up, a total of 20(32.8%) were dead while 32(52.5%) had
recovered fully and 9(14.75%) were still suffering from heart failure. During
follow up, only 8(19.5%) pregnancies were detected. Five(62.5%) patients had
uneventful course while 3(37.5%) developed heart failure again.

Conclusion: Peripartum cardiomyopathy is associated with multiple risk factors
and carries high morbidity and mortality.