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Peripartum cardiomyopathy

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Abstract

Peripartum cardiomyopathy is now increasingly recognized as a cause of heart failure in the later months of pregnancy and early postpartum period. Clinical diagnosis may be challenging as it closely resembles several common medical and obstetric complications. Complex pathogenesis, unpredictable onset, staggered recovery, and unanticipated fetomaternal risks pose unique challenge to clinicians. Prevalence seems to vary with race, geographic location, and diagnostic criteria. The presence of multiple risk factors substantially elevates the risk of PPCM. Transthoracic echocardiographic examination can exclude the majority of the mimickers. Symptomatic presentation is initially limited to, varying grades of low cardiac output syndrome. Rarely, PPCM begins with decompensated heart failure and cardiovascular collapse. Guideline-directed medical therapy involves graded initiation and titration of heart failure medications while ensuring the fetal and neonatal safety. Anesthetic and obstetric management should be individualized to improve fetomaternal outcomes. However, emergent cesarean delivery may be required in women with decompensated heart failure and cardiovascular collapse. An early institution of mechanical circulatory support has shown to improve outcome. Bromocriptine and other experimental drugs designed to target pathogenic pathway have yielded mixed results. A further change in approach to management requires a comprehensive understanding of pathophysiology and fetomaternal safety profiles of heart failure medications.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India

    Nivedita Jha

  2. Cardiothoracic Division, Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India

    Ajay Kumar Jha

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  1. Nivedita Jha
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  2. Ajay Kumar Jha
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NJ helped in conceptualization, methodology, analysis, investigation, data curation, writing, and reviewing the manuscript. AKJ helped in conceptualization, methodology, analysis, investigation, data curation, writing, and reviewing the manuscript.

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Correspondence to Ajay Kumar Jha.

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Jha, N., Jha, A.K. Peripartum cardiomyopathy. Heart Fail Rev 26, 781–797 (2021). https://doi.org/10.1007/s10741-020-10060-y

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