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Prognosis Poor in Persistent Peripartum Cardiomyopathy


 

RIVIERA MAYA, MEXICO — Women whose ejection fraction remains less than 50% after a diagnosis of peripartum cardiomyopathy face a significantly increased risk of cardiac deterioration and death with any subsequent pregnancies, Dr. Bernard Gonik said at a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.

“We know that the patient whose echocardiogram has not normalized within 6 months has a very poor prognosis in terms of future pregnancy,” said Dr. Gonik, the Fann Srere Endowed Chair in Perinatal Medicine at Wayne State University, Detroit.

“Of these women, 50% will have symptoms during a subsequent pregnancy, 33% will experience deterioration of cardiac function, 42% will have persistent cardiomyopathy, and 25% will die.”

These numbers are based on a 2001 review published in the New England Journal of Medicine. That article discussed outcomes in 92 women with the disorder who had a subsequent pregnancy. The article also identified the very poor prognosis for the 20% of women whose cardiac function does not normalize within a period of 6 months postpartum (N. Engl. J. Med. 2001;344:1567–71).

“The prognosis for these women is really bad, with up to 85% dying by 5 years,” Dr. Gonik said at the meeting, sponsored by Boston University. “Almost half of these deaths will occur within the first 6 months post partum.”

Conversely, among women with ejection fractions of more than 50%, only 6% had symptoms with a subsequent pregnancy, 17% deteriorated, 9% had persistent cardiomyopathy, and none died.

Peripartum cardiomyopathy is defined as the development of heart failure during the last month of pregnancy or within 3 months of delivery, in the absence of preexisting heart disease and with no other known cause, Dr. Gonik said.

The condition occurs in about 1 in 5,000 pregnancies. The etiology is unknown.

Risk factors include multiparity, advanced maternal age, twins, preeclampsia, hypertension, and black race.

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