The myriad presentations of peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) is an idiopathic, non-ischemic systolic type of heart failure which can present anytime from the last month of pregnancy till the end of 5th month post-partum. The incidence of PPCM in the Indian population is 1:1340 with 60% of the cases occurring post-partum. PPCM has a mortality rate of 11.7% with unpredictable sequelae ranging from worsening heart failure, cardiogenic shock, development of arrythmias to complete recovery and recurrence in subsequent pregnancies. With an idiopathic aetiology with multiple theories, PPCM remains a diagnosis of exclusion, demanding a high index of suspicion and surveillance in pregnant women. The management involves a multidisciplinary approach involving the obstetrician, cardiologist and at times the anaesthesiologist and includes various drugs like beta- blockers, diuretics, digoxin, bromocriptine. In severe cases, maternal circulatory support may also be needed. We present three cases of PPCM diagnosed in the antepartum, intrapartum and immediate post-partum periods respectively. Out of 3 patients, one delivered vaginally and two underwent emergency caesarean sections. All of patients went home post-delivery with good outcomes and were doing well after 4 weeks of delivery.