Management of pregnancy and childbirth in women with peripartum cardiomyopathy


Дәйексөз келтіру

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Аннотация

Objective: To investigate the clinical characteristics of patients with peripartum cardiomyopathy (PPCM) and the indications, timing, and mode of delivery. Materials and methods: This study retrospectively analyzed medical records of 16 patients diagnosed with PPCM from 2012 to 2021, who were divided into those who developed PPCM before (n=10) and after (n=6) delivery. Results: PPCM manifested before delivery at 26-37 weeks in 62.5% of patients and 6 cases (37.5%) on days 1-9 postpartum. All patients with PPCM had left ventricular heart failure (HF) symptoms with an acute onset manifesting as NYHA functional class III/IV in 37.5% (n=6). Left ventricular ejection fraction (LVEF) at the onset of PPCM ranged from 19 to 45%, with a median of 38.5% (24.75%; 40%). Among the patients with PPCM onset before delivery (n=10), 100% were delivered by cesarean section. Of these, 70% had cardiovascular indications, and three patients (30%) underwent early delivery due to a significant decrease in LVEF with decompensated HF. Ten and 60% of the patients required emergency and urgent Cesarean section, respectively, and 30% had elective surgical delivery due to stable hemodynamics against the background of decreased LVEF. Two patients (12.5%) required mechanical circulatory support systems, and one (6.25%) required heart transplantation. In 87.5% of patients, LVEF was restored to > 45%; mortality was 6.25%. Conclusion: Based on the analysis of PPCM clinical cases managed at the Almazov NMRC, indications for delivery were evaluated. Cardiovascular indications were identified in 70% of patients who had decompensated HF despite the ongoing therapy. Management of pregnancy and childbirth of women with PPCM is determined on a case-by-case basis; therefore, a generalization of the experience, based on the clinical cases of 16 patients, is of great importance for the further development of obstetric clinical protocols.

Толық мәтін

Рұқсат жабық

Авторлар туралы

Irina Zazerskaya

Almazov National Medical Research Centre Ministry of Health of the Russian Federation

Email: zazera@mail.ru
Dr. Med. Sci., Head of the Department of Obstetrics and Gynecology 197341, Russia, Saint-Petersburg, Akkuratova str., 2

Kseniia Rudenko

Almazov National Medical Research Centre Ministry of Health of the Russian Federation

Email: xeniaruru@yandex.ru
Clinical Resident, Research Technician at the Department of Obstetrics and Gynecology 197341, Russia, Saint-Petersburg, Akkuratova str., 2

Natalia Osipova

Almazov National Medical Research Centre Ministry of Health of the Russian Federation; St. Petersburg University

Email: naosipova@mail.ru
Dr. Med. Sci., Associate Professor at the Department of Obstetrics, Gynecology and Reproductive Medicine; Head of Pathologic Pregnancy Department 197341, Russia, Saint-Petersburg, Akkuratova str., 2

Elena Karelkina

Almazov National Medical Research Centre Ministry of Health of the Russian Federation

Email: ekarelkina@mail.ru
Researcher at the Cardiomyopathy Research Laboratory 197341, Russia, Saint-Petersburg, Akkuratova str., 2

Olga Irtyuga

Almazov National Medical Research Centre Ministry of Health of the Russian Federation

Email: olgir@yandexru
PhD, Associate Professor at the Department of Cardiology, Head of the Teaching of the Department of Cardiology 197341, Russia, Saint-Petersburg, Akkuratova str., 2

Andrei Bautin

Almazov National Medical Research Centre Ministry of Health of the Russian Federation

Email: abautin@mail.ru
Dr. Med. Sci., Professor at the Department of Anesthesiology and Reanimatology, Head of the Research Laboratory of Anesthesiology and Reanimatology 197341, Russia, Saint-Petersburg, Akkuratova str., 2

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