A four year experience of peripartum cardiomyopathy in a rural public hospital in south india

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Peripartum cardiomyopathy (PPCM), as defined by the study group on PPCM of Heart Failure Association of the European Society of Cardiology (ESC), is an idiopathic Cardiomyopathy with systolic heart failure occurring towards the end of pregnancy or in the months following delivery, in previously healthy women. The current diagnostic criteria are: - heart failure in the last month of pregnancy or in the first 5 postpartum months - absence of other causes of heart failure - absence of known heart disease predating the development of heart failure. - reduced Left Ventricular Ejection Faction (LVEF) of < 45% or Fractional Shortening < 30% The global incidence of PPCM is variable, the least reported in Japan and the most in Nigeria. The estimates of the incidence in India need more scrutiny because of the difficulties in diagnosing the condition. The current incidence in literature is 1 in 1374 live births. We conducted the study to characterize PPCM among women delivered at a resource-limited setting in South India. Aim To estimate the incidence of PPCM To describe the risk factors and Feto-maternal outcomes and associated mortality To estimate the recovery of cardiac function at the end of one year. Materials and Methods This was a prospective longitudinal study conducted in a rural public hospital in South India, from 2017 to 2020. PPCM was diagnosed in pregnant and puerperal women, in concurrence with global standards. Data included were Age, Parity, Gestational age, Risk factors, Medical Management, Pregnancy outcome and Echocardiography data on diagnosis and at 1-year follow-up. Results - 32 out of 14505 women in the 4-year study period were diagnosed with PPCM. - The incidence of PPCM was 1 in 453 live births. - The mean age was 23.2 years. - 46.8% were primigravidae. - 21.8% had pre-eclampsia. - 100% had breathlessness at presentation (62.5% were in New York Heart Association – Class III). - The mean LVEF on diagnosis was 24.5%. - The Fractional Shortening was 16%. - The Left Ventricular End Diastolic Dimension was 5.8cm. - 18.75% of women were diagnosed antenatally, 75% in the early puerperium and 6.25% in the late puerperium. - 81.3% were delivered by caesarean section. - At 1-year follow up, complete recovery of cardiac function was observed in 65.6% of the women. - There was no maternal mortality or adverse perinatal outcomes. Conclusion Although rare, PPCM is an important cause for Maternal Mortality. Being a diagnosis of exclusion, a high index of suspicion and involvement of a multi-disciplinary team will aid to optimize the Feto-maternal outcomes. Setting up a National PPCM registry will help in establishing the clinical epidemiology, risk factor assessment, screening strategies, diagnostic criteria and management options for mothers suffering from the condition.