A Study of Incidence and outcome of Peripartum Cardiomyopathy in a Tertiary Care Teaching Hospital

Abstract

Background: Heart failure in women associated with pregnancy and the peripartum period is now recognized as a distinctive form of cardiomyopathy. Its prevalence and mortality vary in different geographical locations. There is a paucity of data from our group of the population regarding peripartum cardiomyopathy hence we conducted the study to determine the incidence, aetiology of PPCM in our study group along with treatment and maternal outcomes. Methods: Patients with any parity and age, which are in their peripartum period i.e. one month before delivery or within five months of delivery. Patients presenting with moderate to severe breathlessness at rest or on exertion with palpitations, ankle oedema, or with signs and symptoms of heart failure. Documented systolic dysfunction with the echocardiographic finding of Ejection fraction of <45% and or Fractional shortening <30%, absence of another identifiable cause for the HF. Results: Overall incidence of PPCM in our institution is 9 per 1000 deliveries. Among n=67 PPCM cases, n=26 patients (38.80%) developed PPCM during pregnancy and n=41 patients (61.2%) during postpartum period. The majority of the patients n=49 cases (73.13%) had severe left ventricular systolic dysfunction (EF =30%) and n=10 (14.92%) had moderate left ventricular systolic dysfunction and n=8 had mild LV dysfunction. There was no significant statistical difference in the severity of LV dysfunction between primi and multiparous women. Conclusion: The main factors are advanced maternal age and multiparity. Twin pregnancies are also risk factors for the development of PPCM. Yet another important risk factor was Pre-eclampsia. There is no single explanation for the pathogenesis of PPCM that is relevant for all women. Recognition of symptoms of breathlessness, orthopnea, and pedal edema in the post-partum period with a history of preeclampsia should arouse a high degree of suspicion.