An anaesthetic quandary

Abstract

Anaesthetic management of cardiac disorders in pregnancy has always been complicated and challenging. A rare but extremely fatal entity, peripartum cardiomyopathy (PPCM) is a life-threatening disease affecting the parturient with mortality rates as high as 35–50%. Developing in late pregnancy or immediately after delivery, this unique disorder endangers not only the mother but the baby as well. We report here a case of a 28-year-old female parturient presenting at 37 weeks of gestation for caesarean delivery with recently diagnosed peripartum cardiomyopathy (ejection fraction of 28%) complicated by severe preeclampsia. She developed cardiac failure just before the induction of anaesthesia. She was successfully resuscitated, operated under general anaesthesia and shifted to the critical care unit for further management.

A rare case with double trouble: Peripartum cardiomyopathy and preeclampsia together with placental abruption resulting in both cardiac and kidney failure

“…There are some predictors of poor prognosis of PPCM, and many of these were present in our patient, like preeclampsia, LVEF < 25%, left ventricular end-diastolic dilatation, hypokinetic LV, and the presence of mitral or tricuspid regurgitation and tachyarrhythmia in the postoperative period. [ 3 4 5 6 ] It has been reported that the development of malignant arrhythmias is the most common cause of death in patients with PPCM. [ 7 ] The incidence of AKI in patients with severe preeclampsia is approximately 2%.…”