Maternal and Fetal Outcomes of Subsequent Pregnancies in Women with Peripartum Cardiomyopathy

Elkayam, Uri; Tummala, Padmini P.; Rao, Kalpana; Akhter, Mohammed W.; Karaalp, Ilyas S.; Wani, Omar R; Hameed, Afshan B.; Gviazda, Israel M.; Shotan, Avraham

doi:10.1056/nejm200105243442101

Cited by 451 publications

(227 citation statements)

References 10 publications

Supporting

Mentioning

207

Contrasting

Unclassified

Order By: Relevance

“…The risk of poor outcome of subsequent pregnancy is high in patients with incomplete left ventricular recovery. Even in patients with recovered left ventricular function, there is an increased risk of complications including recurrent HF and reduced LVEF with subsequent pregnancy (118,119).…”

Section: Prognosismentioning

confidence: 99%

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Howlett¹,

McKelvie²,

Costigan³

et al. 2010

Canadian Journal of Cardiology

100

View full text Add to dashboard Cite

Section: Prognosismentioning

confidence: 99%

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Howlett¹,

McKelvie²,

Costigan³

et al. 2010

Canadian Journal of Cardiology

100

View full text Add to dashboard Cite

“…18 Elkayam et al reported that subsequent pregnancies in patients with peripartum cardiomyopathy were associated with significant decrease in left ventricular function and functional status. 19 Fifty percent of the women who were followed up at our institution were still symptomatic at six months postpartum.…”

Section: Discussionmentioning

confidence: 93%

Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre

Ituk

Habib

Polin

et al. 2014

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose This study examines the peripartum anesthetic management and outcomes of women with dilated cardiomyopathy in a large university medical centre over a seven-year period. Principal findings Twenty-five women were included in this series, 18 with a new diagnosis of cardiomyopathy and seven with a history of cardiomyopathy. Sixteen patients (64%) identified themselves as African American, seven (28%) were Caucasian, and two patients (8%) were Hispanic. The median (range) gestational age at the time of a new diagnosis of cardiomyopathy was 29 (7-38) weeks. Eight women (32%) had New York Heart Association class III/IV symptoms at the time of delivery or in the immediate postpartum period. A multidisciplinary team of obstetricians, anesthesiologists, cardiologists, and pediatricians were involved in the care of these women. The median (range) gestational age at the time of delivery was 33.5 (30-40) weeks. There were nine vaginal deliveries and 15 operative deliveries. One patient had fetal loss at 19 weeks gestation. Twelve women had labour induced with an intravenous infusion of oxytocin at a rate of 0.001-0.02 IUÁmin -1 . An oxytocin infusion at a variable rate with a maximum dose of 0.05 IUÁmin -1 was administered after vaginal delivery to maintain uterine tone. Epidural analgesia was initiated prior to induction of labour or in the latent phase of labour. Seven Cesarean deliveries were performed under combined spinal-epidural anesthesia, five were performed under epidural anesthesia, and three women had general anesthesia. Oxytocin was administered via an intravenous infusion at a rate of 0.05-0.2 IUÁmin -1 after operative delivery. One patient had a cardiac arrest on induction of general anesthesia and was successfully resuscitated. There were no maternal or neonatal deaths. Ten women were followed up at our institution and at six months postpartum; 50% of these patients were still symptomatic. Conclusion We report favourable outcomes in 25 pregnant women with dilated cardiomyopathy who were managed by a multidisciplinary team. Résumé

show abstract

“…30 Approximately 75% of cases are diagnosed within the first month postpartum and 45% present in the first week after birth. 31 The incidence of PPCM in the United States is difficult to estimate as the diagnosis overlaps with other cardiomyopathies. The highest incidence of PPCM occurs in African American women compared to other racial groups.…”

Section: Pregnancy and Peripartum Cardiomyopathymentioning

confidence: 99%

“…Eventual recovery of left ventricular systolic function occurred more frequently in women who had an EF of >30% at original diagnosis of PPCM. 31 However, the safety of subsequent pregnancies remains a concern. Elkayam et al report that women with PPCM exhibit a significant decline in left ventricular function with subsequent pregnancies.…”

Section: Pregnancy and Peripartum Cardiomyopathymentioning

confidence: 99%

See 1 more Smart Citation

Heart Failure in Women

Shin

Hamad

Murthy

et al. 2012

Clinical Cardiology

View full text Add to dashboard Cite

Heart failure (HF) has steadily increased in prevalence and affects both males and females equally. Despite this, there has been a significant underrepresentation of women in large scale HF trials. This disparity has lead to a deficit in understanding important gender-based differences in pathophysiology, diagnosis and treatment strategies. We review these gaps and explore a biological basis for varying outcomes. Endogenous estrogen plays an important role in epidemiology and outcome. The administration of exogenous estrogen has had varied success in treatment and is outlined extensively below. Additionally, we highlight unique HF syndromes through pregnancy and important sex-specific issues concerning transplant and mechanical circulatory support. A central theme remains: there is a clear need for increased female recruitment in clinical trials, and more studies exploring the role of gender-based biology in HF treatment. IntroductionThe prevalence of heart failure (HF) has steadily increased and is now the leading cause of hospital admissions in the adult population in the United States. 1 Women constitute approximately one half of the patients hospitalized for HF, and deaths from HF contribute 35% of the total cardiovascular disease (CVD) mortality in women. 1 -3 Despite this, women have been historically under-represented in clinical HF trials. Although the population estimate of women among patients with HF in the Unites States is about 50%, only 17% to 23% of HF randomized controlled trials enrolled women. 4 This disparity has limited our understanding of gender-related differences in HF. The objective of this article is to review the relationships between sex and the epidemiology, etiology, clinical characteristics, therapeutic management, and outcomes in patients with HF.

show abstract

Maternal and Fetal Outcomes of Subsequent Pregnancies in Women with Peripartum Cardiomyopathy

Abstract: Subsequent pregnancy in women with a history of peripartum cardiomyopathy is associated with a significant decrease in left ventricular function and can result in clinical deterioration and even death.

Cited by 451 publications

References 10 publications

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs

Anesthetic management and outcomes of parturients with dilated cardiomyopathy in an academic centre

Heart Failure in Women

Contact Info

Product

Resources

About