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Peripartum Cardiomyopathy

Cunningham, F. Gary, MD; Byrne, John J., MD, MPH; Nelson, David B., MD

doi: 10.1097/AOG.0000000000003011
Contents: Maternal Morbidity and Mortality: Clinical Expert Series
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Peripartum cardiomyopathy is defined by left ventricular dysfunction and development of cardiac failure without a known cause and occurring in the final month of pregnancy and up to 5 months postpartum. Peripartum cardiomyopathy is an important and steadily increasing cause of pregnancy-associated morbidity and mortality. The incidence of peripartum cardiomyopathy in the United States has been estimated recently as 1 in 2,230 births and approximately 1 in 1,000 births worldwide. The etiopathogenesis of peripartum cardiomyopathy remains elusive; however, it is generally thought to be from a two-hit hypothesis in which an underlying cardiomyocyte protein mutation results in apoptosis mediated by vascular and hormonal actions. Clinical recognition is integral to the management of this disease, because there must be careful exclusion of alternative etiologies. Although there are no disease-specific therapies, management of peripartum cardiomyopathy is based on treatment of heart failure and its symptoms, repressing neurohormonal responses, and preventing long-term sequelae. Ventricular function recovery and rates of recurrence of peripartum cardiomyopathy vary by ethnicity and geography. Mortality rates associated with peripartum cardiomyopathy range from 3% to 40%, depending on geographic location. In this review, normal cardiovascular adaptations in pregnancy are summarized and current evidence-based clinical management of the disease is discussed.

Although uncommon, peripartum cardiomyopathy is a significant cause of maternal morbidity and mortality.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas.

Corresponding author: F. Gary Cunningham, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-9032; email: gary.cunningham@utsouthwestern.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Ceara Byrne, MS, MS, for her contribution to the figures.

Each author has indicated that he has met the journal's requirements for authorship.

Received March 14, 2018

Received in revised form April 28, 2018

Accepted June 07, 2018

© 2019 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.