**14.2 Neonatal and obstetric outcomes**

Lower section cesarean delivery was performed in 40% of patients, largely for obstetric indications. Preterm birth was noted in 25 and 5.9% of infants were small for date [37].

#### **Figure 5.**

*Comparative mortality of cardiomyopathies [34].*


#### **Table 1.**

*Risk factors for increased mortality in PPCM.*

#### **14.3 Subsequent pregnancy**

In patients who have recovered or not recovered from left ventricular failure due to PPCM, there is a high risk of PPCM in subsequent pregnancy. Termination of pregnancy may not prevent relapse.

### **15. Prevention**

In patients who have recovered from left ventricular failure due to PPCM, there is a high risk of PPCM in subsequent pregnancy, and so the best way to avoid PPCM is avoid subsequent pregnancy. The literature suggests that the patient or her partner undergo a sterilization procedure or the patient use a highly effective non-estrogen method of contraception. Though the risk of recurrence appears to be less in PPCM patient with recovered LV function and LVEF > 25%, still these patients should receive counseling, including the option of avoidance of subsequent pregnancy due to the risk of relapse of PPCM, heart failure, and death. There is not much evidence on the safety of contraceptives in PPCM patients; it is advised that the estrogenprogestin contraceptives should be avoided in PPCM patients with persistent LV dysfunction because of their potential to increase the risk of thromboembolism [38].

#### **16. Conclusion**

PPCM is a rare but potentially life-threatening disease of pregnancy. PPCM is common in postpartum period. PPCM patient has various risk factor including

**121**

**Author details**

Mohammad A. Imran1

Ahmed Atef Shible4

Hafiz Hamid Habib5

Nissar Shaikh1

M.A. Rahman1

provided the original work is properly cited.

*Peripartum Cardiomyopathy: Facts and Figures DOI: http://dx.doi.org/10.5772/intechopen.85718*

hypertensive disorders of pregnancy. PPCM patients may present with shortness of breath, arrhythmias, pulmonary edema, and thromboembolic signs and symptoms. Echocardiography will essentially diagnose the PPCM, and it also helps in differential diagnosis. The management of PPCM patients is the management of heart failure with special consideration of fetus. Therapy may involve the use of mechanical devices or even cardiac transplant, but the anticoagulation and antiarrhythmic medication plays an important role in the management. The medical management with bromocriptine, immunosuppression, and immunoglobulin is controversial. Commonly the left ventricular function recovers, but in PCCM the maternal mortality is around 10%, and there is increased incidence of cesarean section. In subsequent pregnancy in patient with PCCM, heart failure may be more severe and

may cause death. Family counseling is essential in these patients.

\*, Firdos Ummunnisa2

2 Dr. Halima Al Tamimi, OBGY Center, Doha, Qatar

, Adel Ganaw1

, Mohammad Nayeemuddin1

, Ranjan Matthias1

, Masood Khattak<sup>5</sup>

1 Surgical Intensive Care, Hamad Medical Corporation, Doha, Qatar

3 Apollo Medical College and Research Center, Hyderabad, India

\*Address all correspondence to: nissatfirdous99@gmail.com

4 Clinical Pharmacist, SICU, Hamad Medical Corporation, Doha, Qatar

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

5 Cardiology Department, Heart Hospital Hamad Medical Corporation, Doha, Qatar

, Arshad Chanda1

, Umm-e-Amara3

,

, Moad Ehfeda1

and A.R. Raju Vegesna1

, Muhammad Shakeel Riaz1

, Zia Mahmood1

,

,

, Muhammad Zubair1

,

*Peripartum Cardiomyopathy: Facts and Figures DOI: http://dx.doi.org/10.5772/intechopen.85718*

*Inflammatory Heart Diseases*

**14.3 Subsequent pregnancy**

Age more than 35 years [35]

**15. Prevention**

**Figure 5.**

**Table 1.**

Black race Multiparity

**16. Conclusion**

pregnancy may not prevent relapse.

*Risk factors for increased mortality in PPCM.*

*Comparative mortality of cardiomyopathies [34].*

Worse New York Heart Association functional class Left ventricular ejection fraction (LVEF) ≤ 25%

In patients who have recovered or not recovered from left ventricular failure due to PPCM, there is a high risk of PPCM in subsequent pregnancy. Termination of

In patients who have recovered from left ventricular failure due to PPCM, there is a high risk of PPCM in subsequent pregnancy, and so the best way to avoid PPCM is avoid subsequent pregnancy. The literature suggests that the patient or her partner undergo a sterilization procedure or the patient use a highly effective non-estrogen method of contraception. Though the risk of recurrence appears to be less in PPCM patient with recovered LV function and LVEF > 25%, still these patients should receive counseling, including the option of avoidance of subsequent pregnancy due to the risk of relapse of PPCM, heart failure, and death. There is not much evidence on the safety of contraceptives in PPCM patients; it is advised that the estrogenprogestin contraceptives should be avoided in PPCM patients with persistent LV dysfunction because of their potential to increase the risk of thromboembolism [38].

PPCM is a rare but potentially life-threatening disease of pregnancy. PPCM is common in postpartum period. PPCM patient has various risk factor including

**120**

hypertensive disorders of pregnancy. PPCM patients may present with shortness of breath, arrhythmias, pulmonary edema, and thromboembolic signs and symptoms. Echocardiography will essentially diagnose the PPCM, and it also helps in differential diagnosis. The management of PPCM patients is the management of heart failure with special consideration of fetus. Therapy may involve the use of mechanical devices or even cardiac transplant, but the anticoagulation and antiarrhythmic medication plays an important role in the management. The medical management with bromocriptine, immunosuppression, and immunoglobulin is controversial. Commonly the left ventricular function recovers, but in PCCM the maternal mortality is around 10%, and there is increased incidence of cesarean section. In subsequent pregnancy in patient with PCCM, heart failure may be more severe and may cause death. Family counseling is essential in these patients.
