Peripartum cardiomyopathy in a woman with preeclampsia with twin pregnancy

Abstract

SUMMARYA 27-year-old nulliparous Japanese woman with twin pregnancy developed preeclampsia at gestational week (GW) 26. Cardiac function was checked regularly as women carrying twins with preeclampsia are expected to have increased risk of peripartum cardiomyopathy (PPCM). Although conventional parameters including blood pressure, proteinuria, platelet count and liver function did not indicate early delivery, gradual worsening of left ventricular ejection fraction (LVEF) to 44% and plasma brain-type natriuretic peptide level of 254 pg/mL suggested impending PPCM and a need for early delivery at GW 32. A nadir LVEF value of 35% on postpartum day (PPD) 3 followed by a value of 49% on PPD 32 was seen in this patient with PPCM. This case highlights the risk of PPCM among women with preeclampsia carrying twins and the role of pregnancy termination in the clinical course of PPCM. BACKGROUND

Prospective study on changes in blood variables in pregnant women at higher risk of peripartum cardiomyopathy

“…Therefore, a screening blood test for detection of candidates for echocardiography would be convenient for both pregnant women and physicians. In our previous experience in a patient with impending PPCM, gradual worsening of cardiac function and concomitant and gradual rise in plasma BNP occurred before fulfilling the criteria for diagnosis of PPCM with echocardiography, and an early termination of pregnancy after the diagnosis may have facilitated improvement of cardiac function …”

Gestational Weight Gain in a Woman with Peripartum Cardiomyopathy

“…GWG was 14.7 kg in the current pregnancy, while approximately 30 kg in her previous pregnancy complicated with PPCM. Although not verified, we speculated that the much lower GWG in the current pregnancy may have somewhat contributed to the avoidance of LVEF worsening in the current pregnancy based on our experience in three previous PPCM cases, including two other than the present case; both were twin pregnancies and exhibited greater GWG (25.5 kg in one with height of 1.60 m, pre-pregnancy weight of 53 kg, and delivery at GW 32 [11] and 18.3 kg with the greatest weight gain of 6.0 kg during the last four weeks of gestation and the greatest weight loss of 19.2 kg during one month postpartum among 90 women with twin deliveries at GW≥32 in the other with height of 1.56 m, pre-pregnancy weight of 51 kg, and delivery at GW 34 [12]). GWG may vary according to ethnicity.…”

“…The common presenting symptoms, such as dyspnea, orthopnea, and peripheral edema, suggest excessive water retention in patients with PPCM, and greater gestational weight gain (GWG) preceded PPCM exclusively in our previous three PPCM cases encountered over the past decade [10][11][12]. One of these women became pregnant again 2.5 years later.…”

Peripartum Cardiomyopathy (PPCM): Dual Case Report and Review of Literatures

“…Patient's with PPCM also have an underlying diagnosis of hypertension which can make delay the diagnosis of PPCM and make management of the disease more difficult [7,14,15]. Lastly, multifetal pregnancies have a strong association with the development of PPCM [10,15]. Umazume et al speculate that multifetal pregnancies increase gestational weight, which leads to volume expansion and increase the risk of cardiac overload and strain on the heart [10].…”

“…Lastly, multifetal pregnancies have a strong association with the development of PPCM [10,15]. Umazume et al speculate that multifetal pregnancies increase gestational weight, which leads to volume expansion and increase the risk of cardiac overload and strain on the heart [10].…”