Peripartum cardiomyopathy characteristics and outcome in a tertiary care hospital.

OBJECTIVE

To assess the incidence, risk factors ,maternal and foetal outcome in women with peripartum cardiomyopathy.

METHODS

A descriptive study was conducted in the department of gynae obstetrics Civil Hospital, and Dow University of Health Sciences, Karachi from Oct, 2003 till Sept, 2007. Thirtytwo patients of any parity and age in their last months of pregnancy or within five months of delivery who met the criteria for diagnosis of peripartum cardiomyopathy were included in the study. Their epidemiologic data, risk factors, NYHA class and pregnancy outcomes were recorded till recovery or discharge. Analysis of results was done using descriptive analysis on SPSS version 15.

RESULTS

Thirty two patients presented with PPCM, which was a frequency of 1 per 837 deliveries. The mean age was 32 +/-3 years and the mean parity 3.66 +/- 1.5. All patients were obese with mean body weight of 71.91 +/- 12.9 kg. The most frequent diagnosis of cardiomyopathy was made in 12 (37.57) Balochi and 7 (21.87) mohajir women. Twenty (62.57) presented late in post partum period and 20 (62.58) were in NYHA class IV. Chronic hypertension 10 (31.257), long term tocotysis 6 (18.757), pre-eclampsia 6 (18.757) and multiple pregnancy were main riskfactors. Eighteen (52.527) women had spontaneous vaginal delivery, 2 had assisted vaginal delivery and 2 had twin vaginal delivery. Ten (31.257) required caesarean section. The main complication was congestive cardiac failure in 20 (62.57) patients and 3 maternal deaths occurred. There were 27 live births and 5 perinatal deaths were recorded.

CONCLUSION

This study showed that peripartum cardiomyopathy is associated with high morbidity and mortality. Multiple risk factors are associated with it, the most important being advancing age, parity, obesity, chronic and gestational hypertension and long term tocolysis.