Skip to main content

Peripartum cardiomyopathy: a KKH case series

Introduction

The incidence, presentation and risk factors of peripartum cardiomyopathy in Singapore are not known.

Methods

Seven patients' case notes were reviewed following IRB approval.

Results

Incidence was 1:2,285 deliveries. Symptoms appeared 1 hour post-LSCS delivery intraoperatively to postpartum day 5, with diagnosis within a few days. Dyspnoea, desaturation, frusemide-induced diuresis, and CXR evidence of pulmonary congestion/oedema occurred in all. Troponin I (measured in 6/7 cases) and CKMB (measured in 5/7) were raised, and then (troponin I repeated in 4/6 and CKMB repeated in 3/5) showed a declining trend. BNP and CRP (measured in Case 6 only) were raised. 2D-ECHO showed worst LVEF 25 (19 to 35)%, median (range), at time of diagnosis, <25% (Cases 1 and 3), valvular abnormalities (4/7), LV diastolic dysfunction (2/7), two-chamber enlargement (3/7), one-chamber enlargement (1/7), and follow-up 2D-ECHO (done in 5/7) showed last LVEF 55 (35 to 65)%, median (range) (Cases 1 and 6, <45%), and valvular abnormalities (3/7). All were Asian (except for one German, typical of our hospital's ethnic mix), mean age was 29.7 years (with only one older: 38 years), mean parity was 1.67 (6/7), all had singleton pregnancy, mean BMI was 28.2 (6/7, one with BMI: 36.1), and preterm labour (3/7, two of which had failed tocolysis with oral adalat and i.v. salbutamol), prostin induction of labour (3/7), caesarean delivery (3/7), and postpartum haemorrhage (3/7) were also noted. They were all managed aggressively without delay. Treatment included oxygen therapy (all), intubation, sedation and ventilation (6/7), BiPAP (3/7), pleural drainage (2/7), frusemide, digoxin and ACE inhibitors (for example, perindopril, enalapril) (all), antibiotic(s) for pneumonia (for example, tazocin, coamoxiclav, ceftriaxone, clarithromycin, doxycycline, gentamicin, metronidazole) (6/7), anticoagulant/antiplatelet prophylaxis (for example, fraxiparine, clexane, aspirin, warfarin) (6/7), beta-blockers (for example, carvedilol, bisoprolol, labetalol) (5/7), other inotropes, namely dobutamine (2/7, in one patient with noradrenaline) and milrinone (1/7), and vasodilators, namely GTN and hydralazine (1/7). Total hospitalisation from time of diagnosis was 5 to 9 days. Following 4 (1 to 8) months, median (range), follow-up, 4/7 made full recovery, 1/7 partial recovery, 1/7 temporary recovery, and 1/7 defaulted. Case 2 resulted in a neonatal death.

Conclusions

Possible risk factors are multiparity, preterm labour requiring tocolysis, prostin induction of labour, and postpartum haemorrhage.

Author information

Affiliations

Authors

Corresponding author

Correspondence to MK Shah.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Shah, M., Leo, S., Ocampo, C. et al. Peripartum cardiomyopathy: a KKH case series. Crit Care 15, P13 (2011). https://doi.org/10.1186/cc9433

Download citation

Keywords

  • Enalapril
  • Dobutamine
  • Salbutamol
  • Clarithromycin
  • Carvedilol
\