Peripartum cardiomyopathy

Peripartum cardiomyopathy is diagnosed when features of dilated cardiomyopathy develops in the last one month of pregnancy or within five months of delivery. Clinically there are features of left ventricular dysfunction of varying severity. Sometimes they present with pulmonary edema or cardiogenic shock. The risk peripartum cardiomypathy increases with increasing maternal age. Echocardiography documents the severity of left ventricular dysfunction. Peripartum cardiomyopathy constitutes about 4% of all cardiomyopathies. The incidence varies from 1:3000-4000 pregnancies. It is a form of dilated cardiomyopathy and contributes to 9% of maternal mortality. Mortality estimates range from 25-50%. Future pregnancies are better avoided, though safe pregnancies in those who have fully recovered from the left ventricular dysfunction within six months have been reported. Residual left ventricular dysfunction is a definite risk factor for significant worsening in future pregnancies. Even those who have recovered have been shown to have a drop in ejection fraction during future pregnancies.