Cardiomyopathy of pregnancy in literal terms is development
of heart failure either during pregnancy or following delivery.
·
Find out when she developed PPCM? (Antenatally
or postnatally)
·
Was her previous pregnancy complicated by
hypertension/PET?
·
Is she 40+ years old?
·
Is she Afro-Caribbean descent?
·
Also find out how much was her ejection fraction
on cardiac echo?
Things to check at each antenatal visit:
·
Maternal pulse
·
respiratory rate,
·
pulse oxymetry,
·
Urine for proteinuria
Things to ask at each antenatal visit
·
Any breathing difficulty (h/o breathlessness,
SOB)
·
Any h/o becoming breathless for routine
tasks (Reduced physical capacity)
·
Rule out palpitations
·
Ask any swelling of limbs, face and back
Diagnostic criteria for PPCM
·
Echo is a must to diagnose PPCM
·
Left ventricular ejection fraction <45 p="">
·
Fractional shortening by 30%
·
Enlargement of heart and global dilation of all four chambers and
markedly Lt.ventricular function
Management of pregnancy
·
If develops antenatally, if baby viable and
closer to term, consider elective delivery
·
Thromboprophylaxis once there is impaired left ventricular
dysfunction or arrhythmia
·
Closely liaise with Cardiologist
·
? Three monthly cardiac echo and monthly ECG or
earlier if she becomes symptomatic.
·
Holter monitoring
·
FBC, U/Es, LFTs
Intrapartum and postpartum management
-
Consider intervening the pregnancy, only if she
becomes symptomatic and echo proves PPCM
-
Avoid prolongation of second stage
-
Avoid ergometrine/methylergometrine. This is
because following delivery, there is immediate rise in cardiac output due to
the pressure off from inferior vena cava. Cardiac output increases by 70%
followed by rapid decline to prelabour levels within one hour of delivery.
-
Avoid excessive intravenous fluids.
-
Consider giving Syntocinon by syringe driver rather
than by syntocinon infusion.
-
Encourage early ambulation.
