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History of Peripartum Cardiomyopathy and Current Pregnancy OutcomeEliza M.N (1), Quek Y.S. (1), Woon S.Y. (1), Ravichandan N. (2), Ravichandran J. (1)

1. Hospital Sultanah Aminah Johor Bahru, Malaysia 2. Singapore General Hospital

Objectives Results Conclusions

References

Peripartum cardiomyopathy is an usual and uncommon

form of dilated cardiomyopathy that is often fatal to young

women. It presents clinically with the onset of cardiac failure

in the last month of pregnancy or the first 5 months

postpartum. There should be no obvious aetiology for the

cardiac failure and no evidence of demonstrable heart disease

before the last month of pregnancy. These patients can present

with fatigue, palpitations, nocturia, shortness of breath or

orthopnea to mention a few. Peripartum cardiomyopathy can

also cause complications such as arrhythmias, congestive

cardiac failure and pulmonary emboli and also maternal

mortality which is related directly to recovery of ejection

fraction.

In women with peripartum cardiomyopathy, future

pregnancy is not recommended , because of the concern about

the ability of the dysfunctional heart to handle the increased

cardiovascular load.

This study was done in order to see the outcome of our

patients who were diagnosed to have peripartum

cardiomyopathy in their previous pregnancy and who are

embarking on a new pregnancy currently

Several limitations in our study also needs to be

considered as we had a small group of patients who were

the same ethnicity so it cannot represent the population in

this country as we consists of multiple ethnics. A larger

study which involves all ethnicity should be done in future

so comparisons can be made.

From this study, we could conclude that it is relatively

safe to have another pregnancy without any significant

maternal and perinatal morbidity and mortality provided

thay are looked after a dedicated obstetric and cardiology

team. The physician who cares for the patient should

counsel her about future pregnancies, breastfeeding and

contraception. Recovery of left ventricular function within

6 months is critical for good outcome of future

pregnancies. If a patient regains normal ventricular

function, another pregnancy may be considered, although

there is no guarantee that the condition will not recur and

close attention must be paid to look out for the sign and

symptoms of heart failure.

Results

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Methods

All the 7 patients in this study was of malay ethnicity and this

can be due to Malays being the highest ethnic group in

Malaysia(Table 1). There was no patients categorized as

obese and none had hypertension prior to pregnancy. The

mean ejection fraction was also normalized to 59% (Table 1).

This study was a prospective observational study involving 7

women who were previously diagnosed with peripartum

cardiomyopathy. Their current cardiac status was compared

via an ECHO, the demographic data was reviewed and the

durataion of pregnancy and mode of delivery was measured.

As for perinatal outcome, the Apgar score at 5 minutes,

birthweight upon delivery and gender was observed.

Majority of the patients delivered vaginally and were able to

reach term with a good perinatal outcome. There were no

association between gender and peripartum cardiomyopathy.

There was only 1 baby admitted to the NICU.

1. Jastrow N, Meyer P, Kahiry P, et al. Prediction of complications in pregnant women with cardiac diseases referred to a tertiary center. Int. J Cardiol 2011;151:209-213. 2. Ruth C., Swan L., Steera PJ. Cardiac disease in pregnancy. Curr Opinion Obstet Gynecol 2009;21:508-513. 3. Willem D., Eric B., Balci A., et al. Predictors of pregnancy complications in women with congenital heart disease. European Heart J 2010;31:2124-2132.  4. Samuel CS, Sermer M, Colman JM, et al. Prospective Multicenter Study of Pregnancy Outcomes in Women with Heart Disease. Am Heart Assoc Circulation 2001; 104:515-521.  5. Paul K., Ouyang DW., Fernandes SM., et al. Pregnancy Outcomes in Women with Congenital Heart Disease. Am J Heart Assoc 2006; 113:517-524.

Table 1. Demographic characteristics of study group

Characteristics Study Group

Maternal Age (years) 32.8 ± 2.39

Ethnic Groups

Malay 7 (100)

Body Mass Index (kg/m2) 27.22 ± 2.06

Parity 1.60 ± 0.55

Grandmultipara (Para ≥ 4) 0 (0)

Gestational Hypertension 1 (14.3)

Gestational Diabetes Mellitus 0 (0)

Anaemia in Pregnancy 1 (14.3)

Ejection Fraction in current pregnancy (%) 59 ± 2.24

Data presented as mean ± SD or n (%).

Table 2. Perinatal and Neonatal Outcomes of study group

Characteristics Study Group

Mode of Delivery

Spontaneous Vertex Delivery 5 (71.4)

Elective Caesarean Section 0 (0)

Emergency Caesarean Section 1 (14.3)

Instrumental Assisted Vaginal Delivery 1 (14.3)

Mean Gestational age (weeks) 38.86 ± 1.22

Preterm Delivery 0 (0)

Birth Weight (kg) 3.22 ± 0.19

Apgar Score at 5 minutes 9

Gender of Baby

Boy 3 (42.9)

Girl 4 (57.1)

Admission to NICU 1 (14.3)

Data presented as n (%) or mean ± SD.

Conclusions

Prognosis seems to be dependent on recovery of left

ventricular function. 30% of patients return to baseline

ventricular function within 6 months, and 50% of patients

have a significant improvement in symptoms and

ventricular function.

All the patients in our study who had a history of

peripartum cardiomyopathy before had normal ECHO

findings in their current pregnancy. This may also be due

the fact that they all waited for more than 6 months to

embark on their new pregnancy.