What is peripartum cardiomyopathy?

Peripartum cardiomyopathy is heart failure due to left ventricular systolic dysfunction developing in the last month of pregnancy or within ~5 months postpartum, in a woman with no prior cardiac disease and no other identifiable cause.

It presents with features of heart failure (breathlessness, oedema, fatigue); managed as heart failure (with attention to drug safety in pregnancy/lactation). Some women recover ventricular function; it can recur in future pregnancies.

Clinical relevance. Peripartum cardiomyopathy must be considered when heart failure develops around delivery, as it needs prompt heart-failure treatment.

More Detail

Peripartum cardiomyopathy

A pregnancy-specific cardiomyopathy presenting around delivery.

Definition

• Left ventricular systolic dysfunction (heart failure) developing in the last month of pregnancy or within ~5 months postpartum.
• In a woman with no prior heart disease and no other identifiable cause of the cardiomyopathy.

Presentation

• Features of heart failure - breathlessness, orthopnoea, fatigue, oedema - which can be mistaken for normal late-pregnancy symptoms.
• Diagnosis confirmed by echocardiography (reduced ejection fraction).

Management

• Treat as heart failure (diuretics, afterload reduction - with pregnancy-safe drug choices; ACE inhibitors avoided antenatally but used postpartum), anticoagulation if EF very low.
• Multidisciplinary care; some women recover ventricular function, others have persistent dysfunction.

Future pregnancies

• Risk of recurrence, especially if ventricular function has not recovered - relevant to counselling and contraception.