Treatment

In treating peripartum cardiomyopathy (PPCM) care should be organised by a multidisciplinary team, including a cardiologist, obstetrician, midwife and a paediatrician with specialist knowledge looking after critically ill premature or full term babies.

When PPCM is first diagnosed, decisions on continuing the pregnancy are based on the mother’s state of health, the degree of heart failure and how far the pregnancy has progressed.  Where possible, pregnancy should continue until the outlook for the baby is good.  But this cannot be at the expense of the mother’s life. The decision to end a pregnancy before the baby is viable, or to deliver prematurely is a decision for the mother and the multidisciplinary team.

How the baby is delivered is affected by the health of the mother and how near to full term the baby is. Vaginal delivery may be possible but an emergency C-section may be needed if the mother is very unwell

Recovery

Prognosis depends on the mother’s recovery from heart failure, which is defined as having an ejection fraction of 50 per cent or more or the figure improving by 20 per cent or more. Recovery is usually between three and six months after the birth, but might be as long as four years afterwards.

Most women make a good recovery, and some recover completely.

Delayed diagnosis, poor heart function, black ethnicity, a blood clot in the left ventricle, multiple births and having other illnesses may make recovery slower.  Mothers who show little sign of recovery often need a heart transplant.

Follow-up echos should be performed, as well as pre-discharge scans. Six weeks and six monthly echos are advised afterwards.

Common treatments for PPCM are the same as those with dilated cardiomyopathy. Treatment will vary according to each individual and the severity of symptoms.