Critical Care Obstetrics and Gynecology

Dilemmas in the Management of a Severe Case of Peripartum Cardiomyopathy

Background: Peripartum cardiomyopathy (PPCM) is associated with maternal mortality due to heart failure, sudden death or thromboembolism. Recurrence is common, especially with persistent left ventricular dysfunction, hence advice on contraception should be given.

Case: A 38-year-old Chinese lady, gravida 4 para 1, developed PPCM in 2008. Despite advice on contraception, she conceived again in 2009 and 2013. For the index pregnancy, she withheld her condition of PPCM until 19+6 weeks. Echocardiography showed LVEF of 14%. Despite the quoted mortality risk of 20% with continuation of pregnancy, she declined termination. Multidisciplinary co-management between obstetric, cardiology and anaesthesia decided on delivery by caesarean section at 32+6 weeks, in view of high maternal risk. Delivery proceeded uneventfully and the baby had no significant complications.

Conclusion: The importance of multidisciplinary management in optimizing the care of a patient with complex obstetric risks, and coping with ethical issues of patient autonomy and beneficence are demonstrated.

Author(s):

Krystal Koh Miao Lin,Tan Lay Kok, Tan Eng Loy and Tan Ju Le

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