379: Peripartum cardiomyopathy is a critical manifestation in triplet pregnancy

Abstract

Peripartum cardiomyopathy (PPCM) is a rare disease, and it is associated with high maternal morbidity and mortality. Multifetal pregnancy is a well-known risk factor for PPCM, but the exact incidence and clinical features of PPCM in multifetal pregnancy has not been reported. Thus, this study aimed to evaluate the frequency, clinical and echocardiographic characteristics, and outcomes of PPCM in multifetal pregnancy, especially in triplet pregnancy. We identified 30 women complicated with PPCM among 18,132 women who delivered at Seoul National University Hospital from January 2005 to May 2018. We defined PPCM as follows: 1) heart failure in the last month of pregnancy or within five months postpartum without underlying heart diseases or identifiable causes of heart failure; and 2) on echocardiography, left ventricular end diastolic dimension > 2.7cm/m2 with ① left ventricular ejection fraction (EF) <45% or ② fractional shortening <30%. With dividing women with PPCM into three groups according to the number of fetuses (singleton, twin and triplet pregnancy), we compared the frequency, clinical and echocardiographic characteristics, and outcomes of PPCM among them. The frequency of PPCM increased with fetal number: 0.1% (14/14,291), 0.3% (10/3,487) and 1.7% (6/354) in singleton, twin and triplet pregnancies, respectively (P<0.05). The level of brain natriuretic peptide increased with fetal number, and the left ventricular function at echocardiography showed a gradual deterioration with increasing fetal number (Table). Recovery rate of heart function at follow-up echocardiography within 50 days also significantly lower in multifetal pregnancy (71.4%, 16.7% and 0% in singleton, twin and triplet pregnancy, P<0.05). PPCM in triplet pregnancy is more frequent and shows worse left ventricular function at diagnosis, compared to that in singleton and twin pregnancy. Close observation should be considered in triplet pregnancy for early detection and timely management of PPCM.