**4. Risk factors**

The following are the risk factors for PCCM, even though the etiology of PPCM is still not clear.

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

4.Long-term tocolytic therapy [9].

**5. Etiopathology**

**5.1 Familial**

individuals [12].

**5.2 Myocarditis**

alpha and interleukin-6 [15].

**5.3 Abnormal immune response**

PPCM and control group of patients [12, 16].

5.History of preeclampsia, eclampsia, or peripartum hypertension, the hypertensive disorders of pregnancy are significant predispose for PPCM, and the preeclampsia patient is four times more susceptible for developing PPCM [10].

In the pathology of peripartum cardiomyopathy, the macroscopic view is a pale myocardium, dilated heart often with intramural thrombus in the ventricles. There will be endocardial thickening and pericardial effusion. The myocardial cellular hypertrophy and myofibril degeneration with areas of fibrosis with interstitial edema are the nonspecific findings. In a small group of patients, there are features of myocarditis with the presence of inflammatory cell infiltration of myocardium,

Although PPCM is a separate clinical entity, the exact etiology of PPCM is still

The familial clustering of PPCM is well known; it could be due to genetic or environmental factors. Ancestry with African genomics may be a risk factor and explains the higher prevalence of PPCM in Haiti, Africa, and black women in other countries. The guanine nucleotide-binding protein beta-3 (GNB3) subunit has a polymorphism called C825T. This polymorphism is associated with an increased risk of hypertension, low plasma renin, and cardiac remodeling. GNB3 has a prevalence of 50% in black individuals compared with 10% in white

First time Melvin et al. proposed myocarditis as a cause for PPCM. Myocarditis could be viral or autoimmune. With pregnancy there is increased in susceptibility to both. In another study, endomyocardial biopsies in five patients showed features of myocarditis. The reason for lesser positive biopsy report among the studies may be related to small sample size and timing of biopsy with relation to the onset of symptoms. The incidence of inflammation is greater in patients who are biopsied soon after presentation [13, 14]. The proinflammatory-inflammatory cytokines may play a role in the pathogenesis and progression of PPCM, as the cytokines that are elevated in PPCM compared with controls include tumor necrosis factor (TNF)-

The entrance of fetal cells into the maternal circulation remains in the circulation without rejection due to weak immunogenic paternal haplotype of chorionic cell. If these cells lodge into the cardiac tissue, immune response may be triggered. The raised titres of immunoglobulins and other autoantibodies in patients with PPCM are suggestive of abnormal immune response, whereas other studies found no significant difference in levels of immunoglobulins and other autoantibodies in

focal necrosis, variable hypertrophy, and fibrosis of the myocardium [11].

not known. Following hypothesis had been proposed for the etiology.

1.Age over 30 years, pregnancy with multiple fetuses [6].

