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History of Peripartum Cardiomyopathy and Current Pregnancy Outcome
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Eliza 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
Results
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
All the 7 patients in this study was of malay ethnicity and this
can be due to Malays being the highest ethnic group in
mention a few. Peripartum cardiomyopathy can also cause
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).
Table 1. Demographic characteristics of study group
Characteristics
Study Group
complications such as arrhythmias, congestive cardiac failure
Maternal Age (years)
32.8 ± 2.39
and pulmonary emboli and also maternal mortality which is
Ethnic Groups
related directly to recovery of ejection fraction.
Malay
7 (100)
Body Mass Index (kg/m2)
27.22 ± 2.06
Parity
1.60 ± 0.55
pregnancy is not recommended , because of the concern about
Grandmultipara (Para ≥ 4)
0 (0)
the ability of the dysfunctional heart to handle the increased
Gestational Hypertension
1 (14.3)
Gestational Diabetes Mellitus
0 (0)
Anaemia in Pregnancy
1 (14.3)
Ejection Fraction in current pregnancy (%)
59 ± 2.24
In women with peripartum cardiomyopathy, future
cardiovascular load.
This study was done in order to see the outcome of our
patients who were diagnosed to have peripartum
Data presented as mean ± SD or n (%).
cardiomyopathy in their previous pregnancy and who are
embarking on a new pregnancy currently
Majority of the patients delivered vaginally and were able to
Methods
considered as we had a small group of patients who were
Characteristics
Study Group
the same ethnicity so it cannot represent the population in
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
There was only 1 baby admitted to the NICU.
Boy
3 (42.9)
Girl
4 (57.1)
Admission to NICU
1 (14.3)
Data presented as n (%) or mean ± SD.
Conclusions
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
6 months is critical for good outcome of future
ventricular function. 30% of patients return to baseline
there is no guarantee that the condition will not recur and
ventricular function within 6 months, and 50% of patients
close attention must be paid to look out for the sign and
have a significant improvement in symptoms and
symptoms of heart failure.
ventricular function.
All the patients in our study who had a history of
peripartum cardiomyopathy before had normal ECHO
via an ECHO, the demographic data was reviewed and the
embark on their new pregnancy.
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safe to have another pregnancy without any significant
function, another pregnancy may be considered, although
the fact that they all waited for more than 6 months to
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From this study, we could conclude that it is relatively
Prognosis seems to be dependent on recovery of left
cardiomyopathy. Their current cardiac status was compared
birthweight upon delivery and gender was observed.
so comparisons can be made.
pregnancies. If a patient regains normal ventricular
findings in their current pregnancy. This may also be due
As for perinatal outcome, the Apgar score at 5 minutes,
study which involves all ethnicity should be done in future
contraception. Recovery of left ventricular function within
women who were previously diagnosed with peripartum
durataion of pregnancy and mode of delivery was measured.
this country as we consists of multiple ethnics. A larger
maternal and perinatal morbidity and mortality provided
Gender of Baby
reach term with a good perinatal outcome. There were no
association between gender and peripartum cardiomyopathy.
This study was a prospective observational study involving 7
Several limitations in our study also needs to be
Table 2. Perinatal and Neonatal Outcomes of study group
Mode of Delivery
of pregnancy. These patients can present with fatigue,
palpitations, nocturia, shortness of breath or orthopnea to
Conclusions
References
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women with cardiac diseases referred to a tertiary center. Int. J Cardiol
2011;151:209-213.
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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.