Peripartum cardiomyopathy
Peripartum cardiomyopathy develops during the last trimester or the first 5 months post partum.
The precise aetiology remains unclear, but pre-eclampsia, multiparity and advanced maternal age are
consistently identified as risk factors [8]. Autoimmune processes and oxidative-stress-mediated
cleavage of prolactin have been purported as possible underlying causes, and immunoglobulins and
bromocriptine have been used as treatment, but their efficacy has not yet been established. Therefore,
at present, medical therapy is the same as for other causes of heart failure. These patients also
frequently develop intracardiac mural thrombus, which may embolise and so should be anticoagulated.
Ventricular function may decline rapidly, and mortality is 15-30% [9]. If ventricular
function remains impaired, a subsequent pregnancy carries a 44% risk of recurrence and a 19% risk of
mortality [10]. Even if ventricular function recovers fully, a further pregnancy is associated with a 20%
risk of recurrence.