Peripartum cardiomyopathy

Peripartum cardiomyopathy is a serious, life-threatening disease. An increasingly recognized cause of pregnancy-related maternal mortality, prognosis is highly variable and difficult to predict. Risk factors and incidence vary widely worldwide. Incidence in the United States ranges from 1:1141 to 1:4350 live births, but it ranges from 1:1000 in South Africa to 1:300 in Haiti. About 45 % of cases are identified within 1 week of delivery and 75 % of cases within 1 month. Risk factors range from maternal age > 30 years to the African race, hypertension, multiparity, pregnancy with multiple fetuses, maternal cocaine use, and oral tocolytic therapy. This chapter describes the etiology and clinical presentation of peripartum cardiomyopathy, differential diagnosis, and treatment options. Acute management focuses on oxygenation and hemodynamic support-comparable to managing heart failure during pregnancy. Cardiogenic shock may require vasodilator and inotropic therapy. Some patients require cardiac transplantation. Chronic management includes pharmacological treatment similar to treating idiopathic dilated cardiomyopathy. Data are limited regarding use of defibrillators and cardiac resynchronization therapy, but implanted medical devices pose risks and have no proven clinical benefit. Emerging therapies are very promising but require testing via prospective, double-blinded study to understand their impact on morbidity and mortality. One therapy showing potential is bromocriptine; in one small study, it enabled greater recovery of left ventricular ejection fraction compared to the standard of care.