n Obstetrics and Gynaecology Forum - Peripartum cardiomyopathy : a review of the literature : review




Peripartum cardiomyopathy (PPCM) is often diagnosed and treated late due to a lack of awareness amongst health care workers. There are widespread definitions for peripartum cardiomyopathy, some with strict criteria that may cause some patients to be missed, leading to the proposal of a modified definition. The incidence varies highly between countries and in South Africa it appears to be around 1 in 1000 pregnancies. The precise pathophysiology remains unclear but new evidence points towards a prolactin-oxidative stress cascade. This may in future provide us with a disease specific therapeutic intervention. The clinical presentation is highly varied and the management is similar to management of any patient with heart failure, but in the pregnant patient the teratogenicity of drugs must be considered. Multidisciplinary input is needed especially when managing delivery of these patients. Delivery should take place in a high care area experienced in managing pregnant patients with cardiac disease. The prognosis of patients diagnosed with PPCM varies geographically with roughly a third of patients returning to normal cardiac function and a third showing partial recovery. All patients should be fully counselled about the risk of heart failure in subsequent pregnancies and effective contraception.


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