BACKGROUND Hyponatremia is the most common electrolyte imbalance,however the prognostic significance of hyponatremia in peripartum cardiomyopathy(PPCM)remains unclear.AIM To assess the prognostic significance of hypon...BACKGROUND Hyponatremia is the most common electrolyte imbalance,however the prognostic significance of hyponatremia in peripartum cardiomyopathy(PPCM)remains unclear.AIM To assess the prognostic significance of hyponatremia in PPCM patients.METHODS We consecutively recruited patients with PPCM from 14 sites in Nigeria and followed them up for a median of 18 months.Serum sodium was measured at baseline,and patients with hyponatremia(<135 mmol/L)were compared with those with normal sodium levels.Cox proportional hazards regression models were developed to identify factors associated with all-cause mortality.RESULTS Of the 191 PPCM patients recruited,90(47.1%)had hyponatremia at presentation.All-cause mortality among the hyponatremic patients(24/90;26.7%)was significantly higher than among patients with normal serum sodium(7/101;6.9%)(P-value<0.001).In the Cox proportional hazards regression model,hyponatremia was independently associated with an increased risk of all-cause mortality[hazard ratio:3.18(95%confidence interval:1.35-7.52;P=0.008)],as were hypotension(systolic blood pressure<100 mmHg)[2.22(1.03-4.79);P=0.043]and left ventricular ejection fraction(LVEF)<25%[3.14(1.47-6.73),P=0.003].CONCLUSION Hyponatremia was common in our cohort of PPCM patients,and was independently associated with a threefold increased risk for all-cause mortality.Hypotension and a LVEF below 25%at presentation were also independent predictors of mortality.展开更多
Objective.To analyze the clinical characteris tics of peripartum cardiomyopathy a nd to evaluate the different factors that influence the prognosis of the peripartum cardiomyopathy.Method.A retrospective review was un...Objective.To analyze the clinical characteris tics of peripartum cardiomyopathy a nd to evaluate the different factors that influence the prognosis of the peripartum cardiomyopathy.Method.A retrospective review was undertak en on records of women who were diagnosed with peripartum cardiomyopathy at Peking Union Medi cal College Hospital between Jan.1983and May 1999.Results.During the research period,only 16p regnant women were documented as peripartum cardiomyopa-thy.Some of the women undertook ultr asonic cardiographic(UCG)examination that showed decreased s ystolic function.Seven women were complica ted with pregnancy induced hyperten sion.Three died of disseminated intravascular coagulation,embolism and cardiogenic shock respectively.Conclusion.Early diagnosis of the peripartum ca rdiomyopathy is extremely important.The UCG can pro-vide helpful information on disease progression or regression.展开更多
BACKGROUND While primary liver cancer(PLC)is one of the most common cancers around the world,few large-scale population-based studies have been reported that evaluated the clinical survival outcomes among peripartum a...BACKGROUND While primary liver cancer(PLC)is one of the most common cancers around the world,few large-scale population-based studies have been reported that evaluated the clinical survival outcomes among peripartum and postmenopausal women with PLC.AIM To investigate whether peripartum and postmenopausal women with PLC have lower overall survival rates compared with women who were not peripartum and postmenopausal.METHODS The Taiwan National Health Insurance claims data from 2000 to 2012 was used for this propensity-score-matched study.A cohort of 40 peripartum women with PLC and a reference cohort of 160 women without peripartum were enrolled.In the women with PLC with/without menopause study,a study cohort of 10752 menopausal females with PLC and a comparison cohort of 2688 women without menopause were enrolled.RESULTS Patients with peripartum PLC had a non-significant risk of death compared with the non-peripartum cohort[adjusted hazard ratios(aHR)=1.40,95%confidence intervals(CI):0.89-2.20,P=0.149].The survival rate at different follow-up durations between peripartum PLC patients and those in the non-peripartum cohort showed a non-significant difference.Patients who were diagnosed with PLC younger than 50 years old(without menopause)had a significant lower risk of death compared with patients diagnosed with PLC at or older than 50 years(postmenopausal)(aHR=0.64,95%CI:0.61-0.68,P<0.001).The survival rate of women<50 years with PLC was significantly higher than older women with PLC when followed for 0.5(72.44%vs 64.16%),1(60.57%vs 51.66%),3(42.92%vs 31.28%),and 5 year(s)(37.02%vs 21.83%),respectively(P<0.001).CONCLUSION Peripartum females with PLC have no difference in survival rates compared with those patients without peripartum.Menopausal females with PLC have worse survival rates compared with those patients without menopause.展开更多
Peripartum cardiomyopathy(PPCM) represents new heart failure in a previously heart-healthy peripartum patient. It is necessary to rule out all other known causes of heart failure before accepting a diagnosis of PPCM. ...Peripartum cardiomyopathy(PPCM) represents new heart failure in a previously heart-healthy peripartum patient. It is necessary to rule out all other known causes of heart failure before accepting a diagnosis of PPCM. The modern era for PPCM in the United States and beyond began with the report of the National In-stitutes of Health PPCM Workshop in 2000, clarifying all then-currently known aspects of the disease. Since then, hundreds of publications have appeared, an indi-cation of how devastating this disease can be to young mothers and their families and the urgent desire to find solutions for its cause and better treatment. The purpose of this review is to highlight the important ad-vances that have brought us nearer to the solution of this puzzle, focusing on what we have learned about PPCM since 2000; and what still remains unanswered. Despite many improvements in outcome, we still do not know the actual triggers that initiate the pathological process; but realize that cardiac angiogenic imbalances resulting from complex pregnancy-related immune sys-tem and hormonal changes play a key role.展开更多
Background: Peripartum hysterectomy is the procedure of removing the uterus after vaginal delivery or cesarean birth;it remains a life-saving procedure in cases of severe uterine hemorrhage. Objective: To know the inc...Background: Peripartum hysterectomy is the procedure of removing the uterus after vaginal delivery or cesarean birth;it remains a life-saving procedure in cases of severe uterine hemorrhage. Objective: To know the incidence of peripartum hysterectomy in Misan province, what is the main cause of this procedure, and if there is any change in the incidence of this procedure during a 3 year study period. Method: A descriptive cross sectional study was done in Misan province for all cases of peripartum hysterectomy during the period from 2014-2016. All information regarding present pregnancy, previous obstetric history, the cause of peripartum hysterectomy, any complications & infant outcome, were taken from the case sheet & from the patients themselves. 50 patients were enrolled in this study, and only 30 patients needed peripartum hysterectomy and 20 patients’ uterus were saved by repair surgery. Results: During the study period of 3 years, there was 72,720 deliveries, and during that time 30 peripartum hysterectomies were carried out of the 50 cases studied, which gave an incidence of 0.4/1000 deliveries. The patients were diagnosed as: rupture uterus in 30 (60%) cases, adherent placenta in 14 (28%) & 6 (12%) cases had atonic uterus. The major postoperative complication was anemia which complicated 23 (46%) cases, & then bladder injury 5 (10%). Admission to ICU was needed for 24 (48%) cases. There were 32 (64%) cases needed ≥4 units of blood transfusion. There were 38 (76%) cases stayed in hospital for ≥4 days. The most common cause for peripartum hysterectomy was for adherent placenta (28%) & rupture uterus (20%). Conclusion: The incidence of peripartum hysterectomy was 0.4/1000 (0.04%) deliveries. The most common reason behind peripartum hysterectomy was for adherent placenta and next was for uterine rupture. The rate of this procedure was not changed during the study period.展开更多
Introduction: Peripartum cardiomyopathy (PPCM) is a common clinical condition in northern Nigeria. This study aimed to determine the prevalence and characteristics of PPCM among women with heart failure referred for e...Introduction: Peripartum cardiomyopathy (PPCM) is a common clinical condition in northern Nigeria. This study aimed to determine the prevalence and characteristics of PPCM among women with heart failure referred for echocardiography. Materials and Methods: This is a retrospective study of 401 women managed for heart failure referred for echocardiography between October 2016 and September 2017. Their reports were analyzed for demographic and echocardiographic parameters. Results: The mean age of the 401 individuals studied was 41.28 ± 16.25 years. The commonest cause of heart failure was PPCM, accounting for 256 (69.5%), followed by hypertension 79 (19.7%) and rheumatic heart disease (RHD) 24 (5.9%). Conclusion: PPCM is a common and important cause of heart failure among women in Northern Nigeria.展开更多
Objective To explore the effect of inflammation and autoimmunity in peripartum cardiomyopathy （PPCM）. Methods A total of 82 PPCM patients and 100 normal delivery patients were randomly selected and conducted epidemi...Objective To explore the effect of inflammation and autoimmunity in peripartum cardiomyopathy （PPCM）. Methods A total of 82 PPCM patients and 100 normal delivery patients were randomly selected and conducted epidemiological survey. High-sensitivity C- reaction protein （hs-CRP）, troponin I, human antimyocardial antibody IgG （AMA-IgG）, Coxsackie B virus IgG （CBV-IgG） and adenovirus antibody IgG （ADV- IgG） were detected with ELISA. Results Compared with control group, PPCM patients had older age, higher pressure, higher proportion of cesarean section and infection. The levels of serum hs-CRP, cTNI, and leucocyte were markedly higher in PPCM patients compared with control. The positive proportion of AMA-IgG and CBV-IgG was signifi- cantly increased （P〈0.01） in PPCM patients compared with the control. Logistic regression showed that infection （OR=2.87, 95%CI 1.15-5.24）, increased hs-CRP （OR=1.86, 95%CI 1.08-4.02） and positive AMA-IgG （OR=2.68, 95%CI 1.19-4.85） were independent risk factors for PPCM. Conclusions Inflammation and autoimmunity play an important role in peripartum cardiomyopathy（J Geriatr Cardio12010; 7：106-109）.展开更多
Peripartum cardiomyopathy(PPCM)is a disorder in which heart failure develops in the last month of pregnancy or within the fi rst fi ve months postpartum.The exact etiology is not known although recent studies suggest ...Peripartum cardiomyopathy(PPCM)is a disorder in which heart failure develops in the last month of pregnancy or within the fi rst fi ve months postpartum.The exact etiology is not known although recent studies suggest angiogenic imbalance is a key factor with soluble fms-like tyrosine kinase-1(sFlt1)and a cleaved form of prolactin possibly playing important roles.This review discusses the epidemiology,risk factors,diagnosis,treatment and prognosis of PPCM and highlights recent advances in our understanding of this disorder.展开更多
Introduction: Knowledge of the risks of pregnancy with heart disease is important because the maternal mortality is much higher than the average. Peripartum cardiomyopathy (PPCM) is rare but it is one of major causes ...Introduction: Knowledge of the risks of pregnancy with heart disease is important because the maternal mortality is much higher than the average. Peripartum cardiomyopathy (PPCM) is rare but it is one of major causes of maternal death. We experienced a pregnant patient with severe aortic regurgitation (AR) presented symptoms of acute heart failure. Her heart failure was not better after an emergency cesarean section and aortic valve replacement (AVR) therefore we think that PPCM caused her heart failure. Case presentation: A 35-year-old woman diagnosed as having severe AR became pregnant. No changes in the AR were apparent during pregnancy. However, the patient developed symptoms of acute heart failure at 37 weeks of gestation, and an emergency cesarean section was performed under general anesthesia. Her hemodynamic status worsened after the cesarean section, and AVR was performed. She was supported with percutaneous cardiopulmonary support (PCPS) after the operation. As recovery seemed to take longer than usual, we decided to implant a ventricular assist device (VAD). Her condition improved after VAD placement, but then she died from a cerebral infarction. In this case, the heart failure was an acute-onset even though AR was stable before and after the pregnancy, and the heart failure did not improve after AVR. Therefore, we concluded that PPCM, rather than AR caused her heart failure. Conclusions: We encountered a case of a pregnant patient with severe AR who presented with symptoms of acute heart failure caused by PPCM. The effect of AR to her heart failure could not be easily denied. This delayed the diagnosis of PPCM, which in turn delayed our decision to use a VAD. Therefore, PPCM should be considered when pregnant patients with heart disease present symptoms of heart failure.展开更多
Introduction: Among the hypertensive pathologies of pregnancy, preeclampsia remains the entity responsible for pregnancy complications. Objective: The aim of this work was to determine the frequency of hypertensive pa...Introduction: Among the hypertensive pathologies of pregnancy, preeclampsia remains the entity responsible for pregnancy complications. Objective: The aim of this work was to determine the frequency of hypertensive pathologies in the peripartum, to determine the maternal and neonatal morbidity factors associated with preeclampsia on the one hand, and on the other hand, to other forms of hypertension in the peripartal period. Patients and methods: This is a cross-sectional study of hypertensive pathologies in per partum over a period of 15 months?which have been included any pregnant, parturient and hypertensive childbirth. The data was analyzed using SPSS software version 21.0. Data positioning and dispersion parameters were studied. The factor analysis?was?performed by determining the odds ratio with a 95% confidence interval and a significance level set at p?≤ 0.05. Results: 142 cases of hypertension were collected from a total of 2988 deliveries,?i.e.?a frequency of hypertension of 4.8%. The main form of high blood pressure (HBP) was the isolated HBP at 51.4%. 60.3% of primiparas were preeclamptic [OR 2.47 (CI 1.25 - 4.91)], 63.2% of preeclampsia did not follow prenatal consultations?[OR 2.43 (CI 1.06 - 5.62)], 63.6% of preeclampsia had moderate and severe threat premature delivery [OR 4.57 (CI 2.11?-?9.99)], neonatal hypoxia in the fifth minute was found in 34.4% of newborns of preeclamptic mothers [OR 3.02 (CI 1.44?-?6.34)], hypotrophy was observed in 41.4% of the cases in the preeclamptic patients [OR 5.41 (IC 1, from 55 to 19.57)]. Conclusion: Preeclampsia is significantly associated with maternal and neonatal morbidity.展开更多
Pregnancy and peripartum period leads to Virchow’s triad (hypercoagulability, venous stasis and vascular injury) thereby increasing the risk of thromboembolism by many folds in these patients. Accurate diagnosis of p...Pregnancy and peripartum period leads to Virchow’s triad (hypercoagulability, venous stasis and vascular injury) thereby increasing the risk of thromboembolism by many folds in these patients. Accurate diagnosis of peripartum pulmonary embolism is pertinent for reducing morbidity and mortality. Accurate diagnosis is also vital for avoiding the adverse effects of unwanted anticoagulation in pregnant mother and fetus in a patient wrongly diagnosed with this condition. Computerized tomographic pulmonary angiography has a high specificity and sensitivity in comparison to ventilation/perfusion scan for diagnosis of peripartum pulmonary embolism (PPE). It has a lower fetal radiation exposure and aids in arriving at an alternative diagnosis, if PPE is absent. Low molecular weight heparin is the medication of choice in the treatment of peripartum pulmonary embolism. Thrombolysis is considered in patients with massive PPE and hemodynamic instability, refractory hypoxia or right ventricular dysfunction. Regional anesthesia/analgesia can be given safely in these patients. We report two cases of PPE and review the anesthetic and surgical consideration.展开更多
Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Objective: To assess the incidence, indications, outcomes & c...Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Objective: To assess the incidence, indications, outcomes & complications of peripartum hysterecomty performed in a tertiary care hospital & compare the results with other reports in the literature. Methods: Twenty nine peripartum hysterectomy cases carried out between July 2015 and June 2018 in Enam Medical College & Hospital, Savar, Dhaka were evaluated retrospectively. Maternal characteristics and characteristics of the present pregnancy and delivery, hysterectomy indications, operative complications, postoperative conditions, and maternal and neonatal outcomes were evaluated. Results: Peripartum hysterectomy incidence was found as 7.26 per 1000 deliveries. The most common indication for hysterectomy was placenta previa with morbidly adherent placenta (17/29) followed by post-partum haemorrhage due to uterine atony (6/29) and ruptured uterus (6/29). There were 6 cases of intraoperative bladder injury. We had 5 maternal deaths, 3 of them were due to irreversible shock & 2 due to septicaemia. There were 5 cases of neonatal mortality mostly because of prematurity & asphyxia. All of the placenta previa with placenta accreta cases had at least one previous cesarean section. All 6 ruptured uterus cases had history of previous caesarean section. It was found that blood transfusion was required in all cases. Conclusion: Obstetric hemorrhages are life-threatening clinical conditions & peripartum hysterectomy is a necessary life-saving procedure. Abnormal placentation is the leading cause of emergency peripartum hysterectomy specially in cases with previous cesarean section history.展开更多
Introduction: Peripartum cardiomyopathy (PPCM) is a dilated cardiomyopathy occurring in the last month of pregnancy or the first five months postpartum without pre-existing cardiovascular pathology. It is a major caus...Introduction: Peripartum cardiomyopathy (PPCM) is a dilated cardiomyopathy occurring in the last month of pregnancy or the first five months postpartum without pre-existing cardiovascular pathology. It is a major cause of pregnancy-related heart failure with high morbidity and mortality. In severe forms (10% to 15% of cases), thrombo-embolic complications are the main cause. The initial hemodynamic evolution is totally unpredictable and sometimes extremely brutal and fatal. The objective of this work was to show the often pejorative evolution of PPCM in our country. Methods: We report in this work three serious clinical cases revealing the complications of this PPCM among patients admitted to the cardiology department of the CHUD-B/A in 2022 for heart failure. The data were collected according to the Declaration of Helsinki. Patients and Observations: The first case was a PPCM with severe left ventricular (LV) systolic dysfunction complicated by spontaneous left intraventricular contrast and right superficial sylvian ischemic stroke. The second case reports a global cardiac decompensation of a PPCM with severe LV systolic dysfunction complicated by an apical thrombus. The third case is that of a state of cardiogenic shock complicating a PPCM with severe LV systolic dysfunction. Among our 03 patients presenting these severe forms of PPCM, the evolution, in spite of the symptomatic and prognostic treatments of the heart failure, and even of the complications, was unfavourable with death in two of them. Conclusion: Complications of PPCM are frequent and fatal in Benin.展开更多
BACKGROUND Depression is a common problem in women in childbearing years due to burdens of motherhood and building a family.Few studies estimate the prevalence of antepartum depression compared to those in the postpar...BACKGROUND Depression is a common problem in women in childbearing years due to burdens of motherhood and building a family.Few studies estimate the prevalence of antepartum depression compared to those in the postpartum period.AIM To estimate the prevalence and the severities of peripartum depression and major depressive disorder and their predictors.METHODS This is a longitudinal observation study.It included 200 women scoring≥13 with the Edinburgh Postpartum Depression Scale,indicating presence of symptoms of depression.They had a gestational age of≥6 wk and did follow-ups until the 10^(th) week to 12^(th) weeks postpartum.Information of women's reactions to life circumstances and stressors during the current pregnancy were gathered from answers to questions of the designed unstructured clinical questionnaire.Severities of depression,anxiety,and parenting stress were determined by the Beck Depression Inventory,State-Trait Anxiety Inventory for Adults,and Parenting Stress Index-Short Form,respectively.Psychiatric interviewing was done to confirm the diagnosis of major depression.Measuring the levels of triiodothronine(T3),thyroxine(T4),and thyroid stimulating hormone(TSH)was done in both antepartum and postpartum periods.RESULTS Out of 968(mean age=27.35±6.42 years),20.66%(n=200)of the patients had clinically significant symptoms of depression and 7.44%had major depression.Previous premenstrual dysphoria,post-abortive depression,and depression unrelated to pregnancy and were reported in 43%,8%,and 4.5%of the patients,respectively.Psychosocial stressors were reported in 15.5%of the patients.Antepartum anxiety and parenting stress were reported in 90.5%and 65%of the patients,respectively.Postpartum T3,T4,and TSH levels did not significantly differ from reference values.Regression analysis showed that anxiety trait was a predictor for antepartum(standardized regression coefficients=0.514,t=8.507,P=0.001)and postpartum(standardized regression coefficients=0.573,t=0.040,P=0.041)depression.Antepartum depression(standardized regression coefficients=-0.086,t=-2.750,P=0.007),and parenting stress(standardized regression coefficients=0.080,t=14.34,P=0.0001)were also predictors for postpartum depression.CONCLUSION Results showed that 20.66%of the patients had clinically significant symptoms of depression and 7.44%had major depression.Anxiety was a predictor for antepartum and postpartum depression.Antepartum depression and parenting stress were also predictors for postpartum depression.展开更多
<strong>Introduction:</strong><span style="font-family:Verdana;"> Peripartum cardiomyopathy (PPCM) is a heart failure whose etiology is still unknown. </span><span style="font...<strong>Introduction:</strong><span style="font-family:Verdana;"> Peripartum cardiomyopathy (PPCM) is a heart failure whose etiology is still unknown. </span><span style="font-family:Verdana;">The a</span><span style="font-family:Verdana;">im</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">of work was to study peripartum cardiomyopathy in its epidemiological, clinical, paraclinical and therapeutic aspects at the Tombouctou hospital.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This is a descriptive cross-sectional study carried out in the Medicine Department of the Timbuktu hospital from January 1 to December 31, 2019. It concerned patients who presented heart failure between the 8th month of pregnancy and the first 5 months postpartum.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">D</span><span style="font-family:Verdana;">uring the study</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;">23 patients were collected. Average age of the patients was 23.50 ± 3.50 years with extremes of 16 and 34 years. Incidence of Peripartum cardiomyopathy (PPCM) was 1/345 pregnancies. Average parity was 3.20 with extremes of 1 and 8. Symptoms appeared at postpartum with 87% of cases. A significant delay in diagnosis was observed. Global heart failure was the mode of decompensation with 70%. Electrocardiographic signs were mainly sinus tachycardia (87%) and left ventricular hypertrophy (83%). Cardiac ultrasound showed in all cases dilated cardiomyopathy and it was associated with thrombus in left ventricle cavity for three cases. Left ventricular ejection fraction was severely impaired in 70% of cases. Pulmonary hypertension was significant in 52%.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Most commonly drugs we used in our series at acute stage were duretics: furosemide 100% and spironolactone 70% (100% and 70%) and ACE inhibitors (90%). Beta-blockers (bisoprolol and carvedilol) were used in 15 patients. Bromocriptine (prolactin inhibitor) was used for 2 patients.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Peripartum cardiomyopathy is a serious cardiac complication of pregnancy of unknown cause, common in the African population.</span>展开更多
Background: Peripartum cardiomyopathy (PPCM) is a rare disease that typically affects young, healthy women. Because PPCM is associated with significant mortality, timely diagnosis and management are essential. Ventric...Background: Peripartum cardiomyopathy (PPCM) is a rare disease that typically affects young, healthy women. Because PPCM is associated with significant mortality, timely diagnosis and management are essential. Ventricular tachycardia (VT) is a major complication and contributor to sudden death. Available data on VT in patients with PPCM are limited. Aim: This case report demonstrates the clinical presentation, antenatal care, and management of labor and delivery in a patient with PPCM complicated by VT. Case report: 36-year old patient G4P3 presents at 27 weeks gestation to the emergency department complaining of chest tightness, palpitations, and profuse sweating. Peripartum cardiomyopathy was diagnosed after her last pregnancy a few years prior. Ventricular tachycardia was diagnosed at this visit and treated successfully. The remainder of the pregnancy was uneventful until she had another episode of ventricular tachycardia during labor. Treatment using antiarrhythmics (diltiazem, amiodarone, adenosine) highlights the importance of prompt intervention and the need for a range of therapeutic options. Results: This case demonstrated successful VT management during pregnancy and labor, emphasizing multidisciplinary collaboration, influencing maternal and fetal outcomes positively, providing insights into optimal care strategies. Conclusion: Peripartum cardiomyopathy complicated by ventricular tachycardia is a life-threatening combination. This case highlights the importance of timely diagnosis and management with combined care between cardiologists, maternal fetal medicine specialists and anesthesiologists to prevent morbidities and sudden maternal death.展开更多
Introduction: Peripartum cardiomyopathy (PPCM) is a rare pathology in Western countries but is common in Africa. Its progression is highly variable, left ventricular function improves in almost one-third to one-half o...Introduction: Peripartum cardiomyopathy (PPCM) is a rare pathology in Western countries but is common in Africa. Its progression is highly variable, left ventricular function improves in almost one-third to one-half of patients. In sub-Saharan Africa, there are few prospective cohort studies. We aimed to describe the long-term evolutionary aspects of this pathology in a sub-Saharan African country, so we developed a PPCM registry;here, we present the first results after 2 years of follow-up. Methodology: This work was performed at the cardiology clinic of the Aristide Le Dantec Teaching Hospital of Dakar from January 01, 2017, to January 01, 2021, for a total duration of 4 years. This was an observational, longitudinal prospective study including patients admitted for peripartum cardiomyopathy. Results: During our study, 5372 patients were admitted to the cardiology clinic. Considering the inclusion criteria, 79 patients were consecutively recruited. The mean age was 30.5 ± 6.7 years, ranging from 18 to 42 years. Half of the patients came from rural areas (56.3%), and 78.2% of patients had a low socioeconomic status. Multiparity and twin pregnancies were noted in 72.8% and 20% of the patients, respectively. A total of 91% of patients had advanced NYHA stage 4 heart failure, and 3 patients had cardiogenic shock. Left ventricular dilatation was found in 52 patients, and severe left ventricular systolic dysfunction was found in 50 patients (90.9%). During hospitalization, 19 patients (34.5%) had complications. The evolution in the hospital was favourable in 45 patients (81.8%). The global mortality rate was 7.3% at 2 years. In multivariate analysis, fewer patients with a dilated left ventricle, a severe alteration of the LVEF and an advanced age progressed towards remission. Conclusion: The long-term evolution of PPCM is very variable. Despite a good rate of remission, progression to end-stage heart failure and death is not negligible in cases of advanced maternal age and severe left ventricular impairment.展开更多
Background Use of an emergency peripartum hysterectomy （EPH） as a lifesaving measure to manage intractable postpartum hemorrhage （PPH） appears to be increasing recently around the world,and the indications for EPH...Background Use of an emergency peripartum hysterectomy （EPH） as a lifesaving measure to manage intractable postpartum hemorrhage （PPH） appears to be increasing recently around the world,and the indications for EPH have changed.The object of this study is to identify risk factors associated with EPH.Methods We conducted a case-control study of 21 patients who underwent EPH because of intractable PPH between January 1,2005 and June 30,2013,at the International Peace Maternity and Child Health Hospital Shanghai Jiao Tong University,School of Medicine （IPMCH）.The parametric t-test,chi-square tests and Logistic regression models were used for analysis to identify the risk factors.The results were considered statistically significant when P＜0.05.Results There were 89 178 deliveries during the study period.Twenty-one women had an EPH,with an incidence of 24 per 100 000 deliveries.The loss of blood during postpartum hemorrhage of the EPH group was （5 060.7±3 032.6）ml,and that of the control group was （2 040.8±723.5） ml.There was a significant difference of PHH between the EHP group and the control group （P=0.001）.Independent risk factors for EPH from a logistic regression model were：disseminated intravascular coagulation （DIC） （OR：9.9,95％ CI 2.8-34,P=0.003）,previous cesarean section （OR：5.27;95％ CI：1.48-17.9,P=0.009）,placenta previa （OR：6.9; 95％ CI 1.6-2.9,P=0.008）,the loss of PPH （OR：1.001; 95％ CI 1.001-1.002,P=0.002）,placenta accreta （OR：68; 95％ CI 10-456,P=0.004）,the use of tocolytic agents prenatally （OR：6.55,95％CI 1.34-32.1,P=0.049）,and fetal macrosomia （OR：6.9,95％ CI 1.25-38,P=0.049）.Conclusion Significant risk factors of EPH are DIC,placenta previa,PPH,previous cesarean delivery,and placenta accrete,the use of tocolytic agents prenatally,and fetal macrosomia.展开更多
Heart failure(HF)during pregnancy presents unique challenges due to the complex interplay between physiological changes and underlying cardiac conditions.Pregnancy-induced increases in blood volume,cardiac output,and ...Heart failure(HF)during pregnancy presents unique challenges due to the complex interplay between physiological changes and underlying cardiac conditions.Pregnancy-induced increases in blood volume,cardiac output,and heart rate can exacerbate pre-existing heart diseases or trigger new-onset HF,such as peripartum cardiomyopathy and preeclampsia-related HF.With pregnancy-related physiological changes altering pharmacokinetics,dosage adjustment becomes crucial,making its application limited to carefully selected cases where benefits outweigh the risks.Medication management for these patients requires a meticulous approach.Beta-blockers like metoprolol and bisoprolol are preferred despite limited evidence,and carvedilol may be cautiously used per clinical experience;atenolol is contraindicated for low-birth-weight risk.Diuretics(furosemide,bumetanide)are safe for congestion relief but warrant judicious dosing.Digoxin is generally safe but requires dose adjustment and regular monitoring due to pregnancy-induced pharmacokinetic alterations.Among positive inotropes,dobutamine exhibits favorable safety in pregnancy,whereas milrinone should be used cautiously for hypotension risk.Renin-angiotensin system inhibitors,mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors are all contraindicated owing to risks of fetal malformations,male fetal feminization,and insufficient safety evidence,respectively.展开更多
文摘BACKGROUND Hyponatremia is the most common electrolyte imbalance,however the prognostic significance of hyponatremia in peripartum cardiomyopathy(PPCM)remains unclear.AIM To assess the prognostic significance of hyponatremia in PPCM patients.METHODS We consecutively recruited patients with PPCM from 14 sites in Nigeria and followed them up for a median of 18 months.Serum sodium was measured at baseline,and patients with hyponatremia(<135 mmol/L)were compared with those with normal sodium levels.Cox proportional hazards regression models were developed to identify factors associated with all-cause mortality.RESULTS Of the 191 PPCM patients recruited,90(47.1%)had hyponatremia at presentation.All-cause mortality among the hyponatremic patients(24/90;26.7%)was significantly higher than among patients with normal serum sodium(7/101;6.9%)(P-value<0.001).In the Cox proportional hazards regression model,hyponatremia was independently associated with an increased risk of all-cause mortality[hazard ratio:3.18(95%confidence interval:1.35-7.52;P=0.008)],as were hypotension(systolic blood pressure<100 mmHg)[2.22(1.03-4.79);P=0.043]and left ventricular ejection fraction(LVEF)<25%[3.14(1.47-6.73),P=0.003].CONCLUSION Hyponatremia was common in our cohort of PPCM patients,and was independently associated with a threefold increased risk for all-cause mortality.Hypotension and a LVEF below 25%at presentation were also independent predictors of mortality.
文摘Objective.To analyze the clinical characteris tics of peripartum cardiomyopathy a nd to evaluate the different factors that influence the prognosis of the peripartum cardiomyopathy.Method.A retrospective review was undertak en on records of women who were diagnosed with peripartum cardiomyopathy at Peking Union Medi cal College Hospital between Jan.1983and May 1999.Results.During the research period,only 16p regnant women were documented as peripartum cardiomyopa-thy.Some of the women undertook ultr asonic cardiographic(UCG)examination that showed decreased s ystolic function.Seven women were complica ted with pregnancy induced hyperten sion.Three died of disseminated intravascular coagulation,embolism and cardiogenic shock respectively.Conclusion.Early diagnosis of the peripartum ca rdiomyopathy is extremely important.The UCG can pro-vide helpful information on disease progression or regression.
文摘BACKGROUND While primary liver cancer(PLC)is one of the most common cancers around the world,few large-scale population-based studies have been reported that evaluated the clinical survival outcomes among peripartum and postmenopausal women with PLC.AIM To investigate whether peripartum and postmenopausal women with PLC have lower overall survival rates compared with women who were not peripartum and postmenopausal.METHODS The Taiwan National Health Insurance claims data from 2000 to 2012 was used for this propensity-score-matched study.A cohort of 40 peripartum women with PLC and a reference cohort of 160 women without peripartum were enrolled.In the women with PLC with/without menopause study,a study cohort of 10752 menopausal females with PLC and a comparison cohort of 2688 women without menopause were enrolled.RESULTS Patients with peripartum PLC had a non-significant risk of death compared with the non-peripartum cohort[adjusted hazard ratios(aHR)=1.40,95%confidence intervals(CI):0.89-2.20,P=0.149].The survival rate at different follow-up durations between peripartum PLC patients and those in the non-peripartum cohort showed a non-significant difference.Patients who were diagnosed with PLC younger than 50 years old(without menopause)had a significant lower risk of death compared with patients diagnosed with PLC at or older than 50 years(postmenopausal)(aHR=0.64,95%CI:0.61-0.68,P<0.001).The survival rate of women<50 years with PLC was significantly higher than older women with PLC when followed for 0.5(72.44%vs 64.16%),1(60.57%vs 51.66%),3(42.92%vs 31.28%),and 5 year(s)(37.02%vs 21.83%),respectively(P<0.001).CONCLUSION Peripartum females with PLC have no difference in survival rates compared with those patients without peripartum.Menopausal females with PLC have worse survival rates compared with those patients without menopause.
文摘Peripartum cardiomyopathy(PPCM) represents new heart failure in a previously heart-healthy peripartum patient. It is necessary to rule out all other known causes of heart failure before accepting a diagnosis of PPCM. The modern era for PPCM in the United States and beyond began with the report of the National In-stitutes of Health PPCM Workshop in 2000, clarifying all then-currently known aspects of the disease. Since then, hundreds of publications have appeared, an indi-cation of how devastating this disease can be to young mothers and their families and the urgent desire to find solutions for its cause and better treatment. The purpose of this review is to highlight the important ad-vances that have brought us nearer to the solution of this puzzle, focusing on what we have learned about PPCM since 2000; and what still remains unanswered. Despite many improvements in outcome, we still do not know the actual triggers that initiate the pathological process; but realize that cardiac angiogenic imbalances resulting from complex pregnancy-related immune sys-tem and hormonal changes play a key role.
文摘Background: Peripartum hysterectomy is the procedure of removing the uterus after vaginal delivery or cesarean birth;it remains a life-saving procedure in cases of severe uterine hemorrhage. Objective: To know the incidence of peripartum hysterectomy in Misan province, what is the main cause of this procedure, and if there is any change in the incidence of this procedure during a 3 year study period. Method: A descriptive cross sectional study was done in Misan province for all cases of peripartum hysterectomy during the period from 2014-2016. All information regarding present pregnancy, previous obstetric history, the cause of peripartum hysterectomy, any complications & infant outcome, were taken from the case sheet & from the patients themselves. 50 patients were enrolled in this study, and only 30 patients needed peripartum hysterectomy and 20 patients’ uterus were saved by repair surgery. Results: During the study period of 3 years, there was 72,720 deliveries, and during that time 30 peripartum hysterectomies were carried out of the 50 cases studied, which gave an incidence of 0.4/1000 deliveries. The patients were diagnosed as: rupture uterus in 30 (60%) cases, adherent placenta in 14 (28%) & 6 (12%) cases had atonic uterus. The major postoperative complication was anemia which complicated 23 (46%) cases, & then bladder injury 5 (10%). Admission to ICU was needed for 24 (48%) cases. There were 32 (64%) cases needed ≥4 units of blood transfusion. There were 38 (76%) cases stayed in hospital for ≥4 days. The most common cause for peripartum hysterectomy was for adherent placenta (28%) & rupture uterus (20%). Conclusion: The incidence of peripartum hysterectomy was 0.4/1000 (0.04%) deliveries. The most common reason behind peripartum hysterectomy was for adherent placenta and next was for uterine rupture. The rate of this procedure was not changed during the study period.
文摘Introduction: Peripartum cardiomyopathy (PPCM) is a common clinical condition in northern Nigeria. This study aimed to determine the prevalence and characteristics of PPCM among women with heart failure referred for echocardiography. Materials and Methods: This is a retrospective study of 401 women managed for heart failure referred for echocardiography between October 2016 and September 2017. Their reports were analyzed for demographic and echocardiographic parameters. Results: The mean age of the 401 individuals studied was 41.28 ± 16.25 years. The commonest cause of heart failure was PPCM, accounting for 256 (69.5%), followed by hypertension 79 (19.7%) and rheumatic heart disease (RHD) 24 (5.9%). Conclusion: PPCM is a common and important cause of heart failure among women in Northern Nigeria.
文摘Objective To explore the effect of inflammation and autoimmunity in peripartum cardiomyopathy （PPCM）. Methods A total of 82 PPCM patients and 100 normal delivery patients were randomly selected and conducted epidemiological survey. High-sensitivity C- reaction protein （hs-CRP）, troponin I, human antimyocardial antibody IgG （AMA-IgG）, Coxsackie B virus IgG （CBV-IgG） and adenovirus antibody IgG （ADV- IgG） were detected with ELISA. Results Compared with control group, PPCM patients had older age, higher pressure, higher proportion of cesarean section and infection. The levels of serum hs-CRP, cTNI, and leucocyte were markedly higher in PPCM patients compared with control. The positive proportion of AMA-IgG and CBV-IgG was signifi- cantly increased （P〈0.01） in PPCM patients compared with the control. Logistic regression showed that infection （OR=2.87, 95%CI 1.15-5.24）, increased hs-CRP （OR=1.86, 95%CI 1.08-4.02） and positive AMA-IgG （OR=2.68, 95%CI 1.19-4.85） were independent risk factors for PPCM. Conclusions Inflammation and autoimmunity play an important role in peripartum cardiomyopathy（J Geriatr Cardio12010; 7：106-109）.
文摘Peripartum cardiomyopathy(PPCM)is a disorder in which heart failure develops in the last month of pregnancy or within the fi rst fi ve months postpartum.The exact etiology is not known although recent studies suggest angiogenic imbalance is a key factor with soluble fms-like tyrosine kinase-1(sFlt1)and a cleaved form of prolactin possibly playing important roles.This review discusses the epidemiology,risk factors,diagnosis,treatment and prognosis of PPCM and highlights recent advances in our understanding of this disorder.
文摘Introduction: Knowledge of the risks of pregnancy with heart disease is important because the maternal mortality is much higher than the average. Peripartum cardiomyopathy (PPCM) is rare but it is one of major causes of maternal death. We experienced a pregnant patient with severe aortic regurgitation (AR) presented symptoms of acute heart failure. Her heart failure was not better after an emergency cesarean section and aortic valve replacement (AVR) therefore we think that PPCM caused her heart failure. Case presentation: A 35-year-old woman diagnosed as having severe AR became pregnant. No changes in the AR were apparent during pregnancy. However, the patient developed symptoms of acute heart failure at 37 weeks of gestation, and an emergency cesarean section was performed under general anesthesia. Her hemodynamic status worsened after the cesarean section, and AVR was performed. She was supported with percutaneous cardiopulmonary support (PCPS) after the operation. As recovery seemed to take longer than usual, we decided to implant a ventricular assist device (VAD). Her condition improved after VAD placement, but then she died from a cerebral infarction. In this case, the heart failure was an acute-onset even though AR was stable before and after the pregnancy, and the heart failure did not improve after AVR. Therefore, we concluded that PPCM, rather than AR caused her heart failure. Conclusions: We encountered a case of a pregnant patient with severe AR who presented with symptoms of acute heart failure caused by PPCM. The effect of AR to her heart failure could not be easily denied. This delayed the diagnosis of PPCM, which in turn delayed our decision to use a VAD. Therefore, PPCM should be considered when pregnant patients with heart disease present symptoms of heart failure.
文摘Introduction: Among the hypertensive pathologies of pregnancy, preeclampsia remains the entity responsible for pregnancy complications. Objective: The aim of this work was to determine the frequency of hypertensive pathologies in the peripartum, to determine the maternal and neonatal morbidity factors associated with preeclampsia on the one hand, and on the other hand, to other forms of hypertension in the peripartal period. Patients and methods: This is a cross-sectional study of hypertensive pathologies in per partum over a period of 15 months?which have been included any pregnant, parturient and hypertensive childbirth. The data was analyzed using SPSS software version 21.0. Data positioning and dispersion parameters were studied. The factor analysis?was?performed by determining the odds ratio with a 95% confidence interval and a significance level set at p?≤ 0.05. Results: 142 cases of hypertension were collected from a total of 2988 deliveries,?i.e.?a frequency of hypertension of 4.8%. The main form of high blood pressure (HBP) was the isolated HBP at 51.4%. 60.3% of primiparas were preeclamptic [OR 2.47 (CI 1.25 - 4.91)], 63.2% of preeclampsia did not follow prenatal consultations?[OR 2.43 (CI 1.06 - 5.62)], 63.6% of preeclampsia had moderate and severe threat premature delivery [OR 4.57 (CI 2.11?-?9.99)], neonatal hypoxia in the fifth minute was found in 34.4% of newborns of preeclamptic mothers [OR 3.02 (CI 1.44?-?6.34)], hypotrophy was observed in 41.4% of the cases in the preeclamptic patients [OR 5.41 (IC 1, from 55 to 19.57)]. Conclusion: Preeclampsia is significantly associated with maternal and neonatal morbidity.
文摘Pregnancy and peripartum period leads to Virchow’s triad (hypercoagulability, venous stasis and vascular injury) thereby increasing the risk of thromboembolism by many folds in these patients. Accurate diagnosis of peripartum pulmonary embolism is pertinent for reducing morbidity and mortality. Accurate diagnosis is also vital for avoiding the adverse effects of unwanted anticoagulation in pregnant mother and fetus in a patient wrongly diagnosed with this condition. Computerized tomographic pulmonary angiography has a high specificity and sensitivity in comparison to ventilation/perfusion scan for diagnosis of peripartum pulmonary embolism (PPE). It has a lower fetal radiation exposure and aids in arriving at an alternative diagnosis, if PPE is absent. Low molecular weight heparin is the medication of choice in the treatment of peripartum pulmonary embolism. Thrombolysis is considered in patients with massive PPE and hemodynamic instability, refractory hypoxia or right ventricular dysfunction. Regional anesthesia/analgesia can be given safely in these patients. We report two cases of PPE and review the anesthetic and surgical consideration.
文摘Background: Emergency peripartum hysterectomy (EPH), although rare in modern obstetrics, remains a life-saving procedure in cases of severe hemorrhage. Objective: To assess the incidence, indications, outcomes & complications of peripartum hysterecomty performed in a tertiary care hospital & compare the results with other reports in the literature. Methods: Twenty nine peripartum hysterectomy cases carried out between July 2015 and June 2018 in Enam Medical College & Hospital, Savar, Dhaka were evaluated retrospectively. Maternal characteristics and characteristics of the present pregnancy and delivery, hysterectomy indications, operative complications, postoperative conditions, and maternal and neonatal outcomes were evaluated. Results: Peripartum hysterectomy incidence was found as 7.26 per 1000 deliveries. The most common indication for hysterectomy was placenta previa with morbidly adherent placenta (17/29) followed by post-partum haemorrhage due to uterine atony (6/29) and ruptured uterus (6/29). There were 6 cases of intraoperative bladder injury. We had 5 maternal deaths, 3 of them were due to irreversible shock & 2 due to septicaemia. There were 5 cases of neonatal mortality mostly because of prematurity & asphyxia. All of the placenta previa with placenta accreta cases had at least one previous cesarean section. All 6 ruptured uterus cases had history of previous caesarean section. It was found that blood transfusion was required in all cases. Conclusion: Obstetric hemorrhages are life-threatening clinical conditions & peripartum hysterectomy is a necessary life-saving procedure. Abnormal placentation is the leading cause of emergency peripartum hysterectomy specially in cases with previous cesarean section history.
文摘Introduction: Peripartum cardiomyopathy (PPCM) is a dilated cardiomyopathy occurring in the last month of pregnancy or the first five months postpartum without pre-existing cardiovascular pathology. It is a major cause of pregnancy-related heart failure with high morbidity and mortality. In severe forms (10% to 15% of cases), thrombo-embolic complications are the main cause. The initial hemodynamic evolution is totally unpredictable and sometimes extremely brutal and fatal. The objective of this work was to show the often pejorative evolution of PPCM in our country. Methods: We report in this work three serious clinical cases revealing the complications of this PPCM among patients admitted to the cardiology department of the CHUD-B/A in 2022 for heart failure. The data were collected according to the Declaration of Helsinki. Patients and Observations: The first case was a PPCM with severe left ventricular (LV) systolic dysfunction complicated by spontaneous left intraventricular contrast and right superficial sylvian ischemic stroke. The second case reports a global cardiac decompensation of a PPCM with severe LV systolic dysfunction complicated by an apical thrombus. The third case is that of a state of cardiogenic shock complicating a PPCM with severe LV systolic dysfunction. Among our 03 patients presenting these severe forms of PPCM, the evolution, in spite of the symptomatic and prognostic treatments of the heart failure, and even of the complications, was unfavourable with death in two of them. Conclusion: Complications of PPCM are frequent and fatal in Benin.
文摘BACKGROUND Depression is a common problem in women in childbearing years due to burdens of motherhood and building a family.Few studies estimate the prevalence of antepartum depression compared to those in the postpartum period.AIM To estimate the prevalence and the severities of peripartum depression and major depressive disorder and their predictors.METHODS This is a longitudinal observation study.It included 200 women scoring≥13 with the Edinburgh Postpartum Depression Scale,indicating presence of symptoms of depression.They had a gestational age of≥6 wk and did follow-ups until the 10^(th) week to 12^(th) weeks postpartum.Information of women's reactions to life circumstances and stressors during the current pregnancy were gathered from answers to questions of the designed unstructured clinical questionnaire.Severities of depression,anxiety,and parenting stress were determined by the Beck Depression Inventory,State-Trait Anxiety Inventory for Adults,and Parenting Stress Index-Short Form,respectively.Psychiatric interviewing was done to confirm the diagnosis of major depression.Measuring the levels of triiodothronine(T3),thyroxine(T4),and thyroid stimulating hormone(TSH)was done in both antepartum and postpartum periods.RESULTS Out of 968(mean age=27.35±6.42 years),20.66%(n=200)of the patients had clinically significant symptoms of depression and 7.44%had major depression.Previous premenstrual dysphoria,post-abortive depression,and depression unrelated to pregnancy and were reported in 43%,8%,and 4.5%of the patients,respectively.Psychosocial stressors were reported in 15.5%of the patients.Antepartum anxiety and parenting stress were reported in 90.5%and 65%of the patients,respectively.Postpartum T3,T4,and TSH levels did not significantly differ from reference values.Regression analysis showed that anxiety trait was a predictor for antepartum(standardized regression coefficients=0.514,t=8.507,P=0.001)and postpartum(standardized regression coefficients=0.573,t=0.040,P=0.041)depression.Antepartum depression(standardized regression coefficients=-0.086,t=-2.750,P=0.007),and parenting stress(standardized regression coefficients=0.080,t=14.34,P=0.0001)were also predictors for postpartum depression.CONCLUSION Results showed that 20.66%of the patients had clinically significant symptoms of depression and 7.44%had major depression.Anxiety was a predictor for antepartum and postpartum depression.Antepartum depression and parenting stress were also predictors for postpartum depression.
文摘<strong>Introduction:</strong><span style="font-family:Verdana;"> Peripartum cardiomyopathy (PPCM) is a heart failure whose etiology is still unknown. </span><span style="font-family:Verdana;">The a</span><span style="font-family:Verdana;">im</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">of work was to study peripartum cardiomyopathy in its epidemiological, clinical, paraclinical and therapeutic aspects at the Tombouctou hospital.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This is a descriptive cross-sectional study carried out in the Medicine Department of the Timbuktu hospital from January 1 to December 31, 2019. It concerned patients who presented heart failure between the 8th month of pregnancy and the first 5 months postpartum.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">D</span><span style="font-family:Verdana;">uring the study</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;">23 patients were collected. Average age of the patients was 23.50 ± 3.50 years with extremes of 16 and 34 years. Incidence of Peripartum cardiomyopathy (PPCM) was 1/345 pregnancies. Average parity was 3.20 with extremes of 1 and 8. Symptoms appeared at postpartum with 87% of cases. A significant delay in diagnosis was observed. Global heart failure was the mode of decompensation with 70%. Electrocardiographic signs were mainly sinus tachycardia (87%) and left ventricular hypertrophy (83%). Cardiac ultrasound showed in all cases dilated cardiomyopathy and it was associated with thrombus in left ventricle cavity for three cases. Left ventricular ejection fraction was severely impaired in 70% of cases. Pulmonary hypertension was significant in 52%.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Most commonly drugs we used in our series at acute stage were duretics: furosemide 100% and spironolactone 70% (100% and 70%) and ACE inhibitors (90%). Beta-blockers (bisoprolol and carvedilol) were used in 15 patients. Bromocriptine (prolactin inhibitor) was used for 2 patients.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Peripartum cardiomyopathy is a serious cardiac complication of pregnancy of unknown cause, common in the African population.</span>
文摘Background: Peripartum cardiomyopathy (PPCM) is a rare disease that typically affects young, healthy women. Because PPCM is associated with significant mortality, timely diagnosis and management are essential. Ventricular tachycardia (VT) is a major complication and contributor to sudden death. Available data on VT in patients with PPCM are limited. Aim: This case report demonstrates the clinical presentation, antenatal care, and management of labor and delivery in a patient with PPCM complicated by VT. Case report: 36-year old patient G4P3 presents at 27 weeks gestation to the emergency department complaining of chest tightness, palpitations, and profuse sweating. Peripartum cardiomyopathy was diagnosed after her last pregnancy a few years prior. Ventricular tachycardia was diagnosed at this visit and treated successfully. The remainder of the pregnancy was uneventful until she had another episode of ventricular tachycardia during labor. Treatment using antiarrhythmics (diltiazem, amiodarone, adenosine) highlights the importance of prompt intervention and the need for a range of therapeutic options. Results: This case demonstrated successful VT management during pregnancy and labor, emphasizing multidisciplinary collaboration, influencing maternal and fetal outcomes positively, providing insights into optimal care strategies. Conclusion: Peripartum cardiomyopathy complicated by ventricular tachycardia is a life-threatening combination. This case highlights the importance of timely diagnosis and management with combined care between cardiologists, maternal fetal medicine specialists and anesthesiologists to prevent morbidities and sudden maternal death.
文摘Introduction: Peripartum cardiomyopathy (PPCM) is a rare pathology in Western countries but is common in Africa. Its progression is highly variable, left ventricular function improves in almost one-third to one-half of patients. In sub-Saharan Africa, there are few prospective cohort studies. We aimed to describe the long-term evolutionary aspects of this pathology in a sub-Saharan African country, so we developed a PPCM registry;here, we present the first results after 2 years of follow-up. Methodology: This work was performed at the cardiology clinic of the Aristide Le Dantec Teaching Hospital of Dakar from January 01, 2017, to January 01, 2021, for a total duration of 4 years. This was an observational, longitudinal prospective study including patients admitted for peripartum cardiomyopathy. Results: During our study, 5372 patients were admitted to the cardiology clinic. Considering the inclusion criteria, 79 patients were consecutively recruited. The mean age was 30.5 ± 6.7 years, ranging from 18 to 42 years. Half of the patients came from rural areas (56.3%), and 78.2% of patients had a low socioeconomic status. Multiparity and twin pregnancies were noted in 72.8% and 20% of the patients, respectively. A total of 91% of patients had advanced NYHA stage 4 heart failure, and 3 patients had cardiogenic shock. Left ventricular dilatation was found in 52 patients, and severe left ventricular systolic dysfunction was found in 50 patients (90.9%). During hospitalization, 19 patients (34.5%) had complications. The evolution in the hospital was favourable in 45 patients (81.8%). The global mortality rate was 7.3% at 2 years. In multivariate analysis, fewer patients with a dilated left ventricle, a severe alteration of the LVEF and an advanced age progressed towards remission. Conclusion: The long-term evolution of PPCM is very variable. Despite a good rate of remission, progression to end-stage heart failure and death is not negligible in cases of advanced maternal age and severe left ventricular impairment.
文摘Background Use of an emergency peripartum hysterectomy （EPH） as a lifesaving measure to manage intractable postpartum hemorrhage （PPH） appears to be increasing recently around the world,and the indications for EPH have changed.The object of this study is to identify risk factors associated with EPH.Methods We conducted a case-control study of 21 patients who underwent EPH because of intractable PPH between January 1,2005 and June 30,2013,at the International Peace Maternity and Child Health Hospital Shanghai Jiao Tong University,School of Medicine （IPMCH）.The parametric t-test,chi-square tests and Logistic regression models were used for analysis to identify the risk factors.The results were considered statistically significant when P＜0.05.Results There were 89 178 deliveries during the study period.Twenty-one women had an EPH,with an incidence of 24 per 100 000 deliveries.The loss of blood during postpartum hemorrhage of the EPH group was （5 060.7±3 032.6）ml,and that of the control group was （2 040.8±723.5） ml.There was a significant difference of PHH between the EHP group and the control group （P=0.001）.Independent risk factors for EPH from a logistic regression model were：disseminated intravascular coagulation （DIC） （OR：9.9,95％ CI 2.8-34,P=0.003）,previous cesarean section （OR：5.27;95％ CI：1.48-17.9,P=0.009）,placenta previa （OR：6.9; 95％ CI 1.6-2.9,P=0.008）,the loss of PPH （OR：1.001; 95％ CI 1.001-1.002,P=0.002）,placenta accreta （OR：68; 95％ CI 10-456,P=0.004）,the use of tocolytic agents prenatally （OR：6.55,95％CI 1.34-32.1,P=0.049）,and fetal macrosomia （OR：6.9,95％ CI 1.25-38,P=0.049）.Conclusion Significant risk factors of EPH are DIC,placenta previa,PPH,previous cesarean delivery,and placenta accrete,the use of tocolytic agents prenatally,and fetal macrosomia.
基金Supported by National Key R and D Program of China,No.2022YFC3500704National Natural Science Foundation of China,No.82305376+1 种基金Project of Supporting Young Scientific and Technological Talents in Jiangsu Province in 2024,No.JSTJ-2024-380College Students'Innovative Entrepreneurial Training Plan Program,No.202310315029Z.
文摘Heart failure(HF)during pregnancy presents unique challenges due to the complex interplay between physiological changes and underlying cardiac conditions.Pregnancy-induced increases in blood volume,cardiac output,and heart rate can exacerbate pre-existing heart diseases or trigger new-onset HF,such as peripartum cardiomyopathy and preeclampsia-related HF.With pregnancy-related physiological changes altering pharmacokinetics,dosage adjustment becomes crucial,making its application limited to carefully selected cases where benefits outweigh the risks.Medication management for these patients requires a meticulous approach.Beta-blockers like metoprolol and bisoprolol are preferred despite limited evidence,and carvedilol may be cautiously used per clinical experience;atenolol is contraindicated for low-birth-weight risk.Diuretics(furosemide,bumetanide)are safe for congestion relief but warrant judicious dosing.Digoxin is generally safe but requires dose adjustment and regular monitoring due to pregnancy-induced pharmacokinetic alterations.Among positive inotropes,dobutamine exhibits favorable safety in pregnancy,whereas milrinone should be used cautiously for hypotension risk.Renin-angiotensin system inhibitors,mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors are all contraindicated owing to risks of fetal malformations,male fetal feminization,and insufficient safety evidence,respectively.
