Peripartum Cardiomyopathy: An Analysis of Clinical Profiles and Outcomes from a Tertiary Care Center in Northern India

Abstract

Objective: The present study was conducted to evaluate the clinical profile, and risk factors of peripartum cardiomyopathy (PPCM) and its association with maternal and fetal outcomes from a tertiary care center in Northern India. Methods: An observational cohort study was conducted on 19 pregnant females showing features of heart failure in the last month of pregnancy or 5 months postpartum. We analyzed the clinical profiles and outcomes in these women with PPCM. Results: The mean age of presentation was 27.9 years with a mean gestational age of 34.9 weeks. 68.4% were primigravida. The most commonly associated comorbidities were anemia and preeclampsia/eclampsia. Breathlessness was present in all women with maximum presenting with class IV breathlessness. The mean baseline ejection fraction (EF) was 34%. A significant change (P < 0.05) was observed in various echo parameters (left ventricular [LV] end diastolic volume; LV end systolic volume; LV strain; EF; right ventricular systolic excursion velocity; left atrial diameter) from baseline to 3 months. Maternal and fetal deaths occurred in 5.2% and 31.5% of subjects, respectively. Cardiogenic shock and significantly reduced EF were associated with adverse fetal and maternal outcomes. Conclusion: The majority of the study participants were young primigravidas with preeclampsia and anemia being strongly associated risk factors. PPCM with poor LVEF and shock is associated with adverse fetal and maternal outcomes. Larger studies with a higher number of patients are needed to study PPCM in detail in the Indian subset.

Keywords

• cardiogenic shock
• echocardiography
• fetal mortality
• peripartum cardiomyopathy