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Licensed Unlicensed Requires Authentication Published by De Gruyter May 30, 2014

Peripartum cardiomyopathy – risk factors, characteristics and long-term follow-up

  • Hagit Shani , Rafael Kuperstein , Alla Berlin , Michael Arad , Ilan Goldenberg and Michal J. Simchen EMAIL logo

Abstract

Aims: Peripartum cardiomyopathy (PPCM) is an infrequent form of cardiomyopathy causing significant maternal morbidity and mortality. We aimed to evaluate the risk factors, characteristics and prognosis of PPCM during the index and subsequent pregnancies.

Methods: A retrospective cohort of 36 women with PPCM in a tertiary medical center was analyzed and compared with 10,370 women who gave birth during a single calendar year at the same institution.

Results: Women diagnosed with PPCM were older (mean 33.5 years) than controls. A significantly higher proportion were primiparous (63.9%), carried multifetal pregnancies (33.3%) and had hypertensive pregnancy complications (38.9%). Thirty-six percent of PPCM patients conceived with in vitro fertilization, and six of them received ovum donation. Twenty-two women had severe left ventricular dysfunction at diagnosis, and these women tended to remain with residual disease, compared with women with milder ventricular dysfunction at diagnosis. Eight patients recovered completely within 2 weeks of diagnosis. Women who recovered early (n=8) had significantly higher ejection fractions on last follow-up compared with women (n=28) who had late or partial recovery. Nine women had 14 additional pregnancies; of them eight women had normal cardiac functions on subsequent pregnancy.

Conclusions: Risk factors for peripartum cardiomyopathy include primiparity, hypertension and multifetal pregnancies. Assisted reproduction techniques are not independently associated with PPCM but rather through other risk factors for PPCM. The degree of cardiac dysfunction at diagnosis and time to recovery are important prognostic factors.


Corresponding author: Michal J. Simchen, MD, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, 52621, Israel, Tel.: + 972-3-5302169, Fax: + 972-3-5302922, E-mail:
aReprint requests should be sent to: Hagit Shani, MD, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat Gan, 52621, Israel, Tel.: + 972-3-5302169, Fax: + 972-3-5302922, E-mail: Hagit.Shani@sheba.health.gov.il

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The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2014-3-9
Accepted: 2014-5-5
Published Online: 2014-5-30
Published in Print: 2015-1-1

©2015 by De Gruyter

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