*10.3.1 Wearable cardioverter-defibrillators*

Further multicenter trial would be valuable to establish if these devices are beneficial; in a single smaller study, it was found to be useful.

#### **10.4 Medical investigational therapy**

Following therapies are not recommended for PPCM patients as its efficacy and safety have not been established.

#### *10.4.1 Bromocriptine*

The use of bromocriptine therapy in PPCM patients is controversial. The preliminary data have shown a benefit of bromocriptine in PPCM patients, but further studies are needed to establish safety and efficacy; it is suggested not to routinely use bromocriptine in PPCM patients. Its use is based upon experimental animal studies of prevention of PPCM by prolactin blockade with bromocriptine. Smaller and observational reports showed the beneficial response to bromocriptine therapy in patients with PPCM [29].

A multicenter study showed that the rate of full recovery (LVEF ≥ 50%) was not significantly higher in the 8-week group compared with the 1-week group. The patients in this trial had better outcomes than observed in prior series, but a placebo control group was not included in the study [30]. One should start anticoagulation in PPCM patients treated with bromocriptine, as the risk of thromboembolic complications.

#### *10.4.2 Immunosuppressive therapy*

The advantage of immunosuppressive therapy has been found to be useful in PPCM patients with biopsy-proven myocarditis, but its efficacy is unclear, and empiric immunosuppression in the absence of evidence of a responsive form of myocarditis is not recommended [31]. These medications have significant side effects.

#### *10.4.3 Intravenous immunoglobulin*

This therapy is tried in patients with myocarditis or newly onset dilated cardiomyopathy with no clear evidence of clinical benefit, and the efficacy of this approach has not been confirmed in any type of myocarditis.

**119**

for date [37].

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

mechanical circulatory support [12].

**12. Breastfeeding**

failure medications [32].

of cesarean section up to 40% [33].

**14.1 Maternal morbidity and mortality**

mortality in PPCCM patients (**Table 1**).

**14.2 Neonatal and obstetric outcomes**

an-d defibrillator or pacemaker implantation [36].

**13. Complications**

**14. Prognosis**

In PPCM patient the risks and benefits of early delivery should be considered and discussed. The 2010 European Society of Cardiology working group statement advised that early delivery is not required if the maternal and fetal conditions are stable. But the patient-related factors, gestational age, cervical status, fetal status, and the potential cardiovascular impact of continuing pregnancy must be considered in timing delivery. The decisions regarding timing and mode of delivery should be based on combined multidisciplinary meeting. In PPCM patients with advanced heart failure, prompt delivery of fetus is indicated for maternal cardiovascular indications and hemodynamic instability. The elective cesarean delivery is preferred for PPCM patients with advanced heart failure requiring inotropic therapy or

According to the expert group, breastfeeding is to be avoided because of the potential effects of prolactin subfragments, but in a study where PPCM patients chose to breastfeed, none had adverse maternal effects, and that rate of recovery of left ventricular function was significantly higher in lactating women, and accordingly given the benefits of breastfeeding, it is recommended that women who are stable should continue breastfeeding as long as it is compatible with their heart

The most common complication is thromboembolism. A premature delivery rate of 25% has been reported in cases with PPCM. PPCM cases had increased incidence

The overall reported mortality rate in PPCM is better than other cardiomyopathy (**Figure 5**) patients approximately 10% in 2 years and 11–29% in 3 years [15]. Cardiac transplantation rates of less than 1–2% per year [15]. The mortality in PPCM patient is commonly caused by progressive pump failure, sudden death, or thromboembolic events. The following factors have been shown to increase the

PPCM is associated with a significant morbidity including brain injury, cardiopulmonary arrest, fulminant pulmonary edema, thromboembolic complications,

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

**11. Delivery**
