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围产期心肌病

Peripartum Cardiomyopathy.

作者信息

Shrikhande Laxmi, Shrikhande Aditya, Shrikhande Bhushan

机构信息

Shrikhande Hospital and Research Centre Pvt Ltd., 34/2 Abhyankar Road, Dhantoli,, Nagpur, Maharashtra 440012 India.

出版信息

J Obstet Gynaecol India. 2022 Oct;72(5):377-381. doi: 10.1007/s13224-022-01621-2. Epub 2022 Jun 2.

Abstract

Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure (HF) that affects women late in pregnancy or in the early puerperium. There are several definitions for PPCM. While there are numerous potential mechanisms for Peripartum (post-partum) cardiomyopathy, its exact cause remains unknown, but the etiopathogenesis is likely to be multifactorial. PPCM is uncommon before 36 weeks of pregnancy, and afflicted women generally present during the first month after delivery. PPCM should be differentiated from pre-existing cardiomyopathy, undiagnosed congenital heart disease, pre-existing valvular heart disease, myocardial infarction, pulmonary embolism and diastolic heart failure due to hypertensive heart disease. The principles for treating acute HF caused by PPCM are the same as those for acute HF caused by any other cause with some limitations during pregnancy. Prompt treatment is critical. There is no necessity for an early delivery unless the maternal or foetal health has deteriorated. In women who present with advanced HF with haemodynamic instability, urgent delivery, regardless of gestation, may be considered. Because women with PPCM have a significant chance of relapse in subsequent pregnancies, they need comprehensive contraceptive counselling. In general, the prognosis is good, with more than half of the patients regaining LV function spontaneously within six months of giving birth. Our aim is to put forth an in-depth review of the Peripartum Cardiomyopathy in contemporary practice.

摘要

围产期心肌病(PPCM)是心力衰竭(HF)的一种罕见病因,影响妊娠晚期或产褥早期的女性。PPCM有多种定义。虽然围产期(产后)心肌病有许多潜在机制,但其确切病因仍不清楚,但其发病机制可能是多因素的。PPCM在妊娠36周前并不常见,患病女性通常在分娩后的第一个月出现。PPCM应与既往存在的心肌病、未诊断的先天性心脏病、既往存在的瓣膜性心脏病、心肌梗死、肺栓塞以及高血压性心脏病导致的舒张性心力衰竭相鉴别。治疗PPCM所致急性HF的原则与治疗其他任何病因所致急性HF的原则相同,但在妊娠期间有一些限制。及时治疗至关重要。除非母婴健康状况恶化,否则无需提前分娩。对于出现严重HF且血流动力学不稳定的女性,无论孕周如何,可考虑紧急分娩。由于患有PPCM的女性在后续妊娠中有显著的复发几率,她们需要全面的避孕咨询。一般来说,预后良好,超过一半的患者在分娩后六个月内可自发恢复左心室功能。我们的目的是对当代实践中的围产期心肌病进行深入综述。

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