Peripartum cardiomyopathy: Clinical Predictors of favourable maternal-fetal outcomes

Abstract

Objectives: To evaluate maternal cardiac complications fetal outcomes, and delivery considerations in patients diagnosed with peripartum cardiomyopathy(PPCM) in tertiary hospital.

Methodology: It was a prospective observational study, conducted in the Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar, from January 17, 2024 to December 17, 2024 after obtaining ethical approval. It included all patients with PPCM admitted via emergency or OPD. Peripartum cardiomyopathy was diagnosed according to European Society of Cardiology criteria, defined as heart failure occurring toward the end of pregnancy or in the months following delivery, with left ventricular ejection fraction <45%, in the absence of another identifiable cause of cardiomyopathy. A total of 46 patients were enrolled. Patients with pre-existing dilated cardiomyopathy, chronic obstructive pulmonary disease and significant congenital valvular heart disease had been excluded. All patients were managed by a Multidisciplinary team, including a consultant Obstetrician, Consultant Cardiologist, a Cardiac Electrophysiologist, an anaesthetist, an intensivist and a paediatrician in a tertiary hospital. Primary outcome were Maternal cardiac complications and mortality. While secondary outcomes were Fetal outcomes (live birth, preterm birth, IUFD, miscarriage) and mode of delivery. Predictors and outcomes of PPCM in patients were assessed, i.e. ejection fraction, fractional shortening, BMI, pre-eclampsia, multiple pregnancy, parity and age. We categorized our sample into two groups based on presence or absence of defined outcomes of cardiac complications and compare predictors between these two groups.

Results: Clinical characteristics observed in patients with relatively stable outcomes included normal BMI, mean age less than 30 years, mean ejection fraction of 37% with no thrombus, no pre-eclampsia or multiple pregnancy. The mode of delivery preferred was elective c-section 65.2% (n=30) decided by MDT (cardiologist, anaesthetist, and obstetrician) to avoid stress of bearing down during labor if EF less than 37.7%. The most common cardiac complication was pulmonary hypertension. The Neonatal outcomes included 71.8% live births, IUFD 19.6% and miscarriages 8.7%.

Conclusion: Maternal outcomes were generally favorable when patients with peripartum cardiomyopathy were managed at a tertiary care center through a multidisciplinary team approach. Better outcomes were commonly observed in patients with normal BMI, mean left ventricular ejection fraction ≥37.7%, absence of pre-eclapmia and multiple pregnancy.