Management of Peripartum Cardiomyopathy as ChallengeCollaboration Between Cardiologists and Obstetricians

Abstract

Peripartum Cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presented the last trimester during pregnancy or few months after the delivery and is associated with left ventricular systolic dysfunction. The incidence of PPCM is highly variable depending on the race and geographic regions, maternal age, multiple gestation pregnancies, hypertensive disorders of pregnancy. Diagnosis is often delayed, as symptoms misinterpreted those of normal pregnancy. During pregnancy cardiac images are limited in modalities that do not allow any sort of radiation but echocardiography is safe and should be performed in any suspected case of heart failure. The clinical outcome of PPCM is also diverse from complete recovery to death. In women with PPCM although the treatment and medical therapy are similar to those in patients with HF with reduced ejection fraction due to other causes requires special modifications for fetal safety. The mode of delivery in patients with PPCM during pregnancy should be discussed with cardiologists, obstetrics, anesthetists and neonatologist that should work together for the treatment of such patients and to minimize the risk for mother and the fetus. It is considered very risky for the patients to consider another pregnancy if the LV function is not recovered to normal and the patients have to be very aware for such a situation. Pre-conception cardiologic evaluation are important for every woman with a cardiomyopathy who is considering having a family