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peripartum cardiomyopathy: A puzzle closer to solution

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World Journal of Cardiology 2014年第3期6卷 87-99页

作者： James D Fett Investigations of Pregnancy Associated Cardiomyopathy (IPAC) Peripartum Cardiomyopathy Network of North America (PCN)Cardiovascular InstituteUniversity of Pittsburgh Medical Center Department of Adult Medicine Hospital Albert Schweitzer

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.

关键词： peripartum cardiomyopathy Pregnancy Heart failure

peripartum Cardiomyopathy: Epidemiological, Clinical, Para-Clinical and Therapeutic Aspects at the Tombouctou Hospital

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World Journal of Cardiovascular Diseases 2021年第3期11卷 167-180页

作者： Souleymane Mariko Massama Konaté Samba Sidibé Karamoko Kantako Charles Dara Djibril Kassogué Nouhoum Diallo Coumba A. Thiam Aniessa Kodio Mariam Sako Abdoul Karim Sacko Mamadou Diakité Souleymane Coulibaly Ilo Bella Diall Ichaka Menta General Medicine Service Tombouctou Hospital Tombouctou Mali Cardiology Department Mali Hospital Bamako Mali Cardiology Department Point G Hospital University Center Bamako Mali Department of Pediatrics Tombouctou Hospital Tombouctou Mali Cardiology Department Kati Hospital University Center Kati Mali Cardiology Department Ségou Hospital Ségou Mali Cardiology Department Gabriel Touré Hospital University Center Bamako Mali

Introduction: peripartum cardiomyopathy (PPCM) is a heart failure whose etiology is still unknown. The aim of work was to study peripartum cardiomyopathy in its epidemiological, clinical, paraclinical and therapeutic ... 详细信息

Introduction: Peripartum cardiomyopathy (PPCM) is a heart failure whose etiology is still unknown. The aim of work was to study peripartum cardiomyopathy in its epidemiological, clinical, paraclinical and therapeutic aspects at the Tombouctou hospital. Methods: 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. Results: During the study,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%.

peripartum Hysterectomy in Misan Province during 2014-2016

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Open Journal of Obstetrics and Gynecology 2017年第2期7卷 258-268页

作者： Saba J. Al Heshemi Department of Gynecology & Obstetrics in College of Medicine College of Medicine Misan University Misan Iraq

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.

关键词： peripartum Hysterectomy Primary Postpartum Hemorrhage Rupture Uterus Adherent Placenta

peripartum pulmonary embolism: Anesthetic and surgical considerations

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Open Journal of Obstetrics and Gynecology 2013年第1期3卷 158-164页

作者： Nissar Shaikh Firdous Ummunnisa Naseera Aboobacker Mustafa Gazali Ousama Kokash Department of Anesthesia Hamad Medical Corporation Weil Cornell Medical College Doha Qatar Department of OBGY Hamad Medical Corporation Doha Qatar

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.

关键词： peripartum Pulmonary Embolism Computerized Tomographic Pulmonary Angiography Low Molecular Weight Heparin

Hypertensive Pathologies in peripartum: Complications and Maternal and Neonatal Outcome

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Open Journal of Obstetrics and Gynecology 2020年第2期10卷 311-318页

作者： Isango Idi Yves Criss Koba Mjumbe Kabamba Nzaji Michel Malamba Lez Didier Kakisingi Ngama Christian Kiopin Mubinda Patrick Mwilambwe Ngoy Steve Manika Muteya Michel Ngwe Thaba Jules Mwembo Tambwe Albert Kalenga Muenze Prosper Department of Gynecology and Obstetrics Faculty of Medicine of the University of Lubumbashi Lubumbashi DR Congo Department of Public Health of the University of the University of Lubumbashi Lubumbashi DR Congo Department of Internal Medicine Faculty of Medicine of the University of Lubumbashi Lubumbashi DR Congo

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.

关键词： Hypertensive Pathology peripartum Complications Maternal and Neonatal Outcomes

Assessment of the Cases Undergone peripartum Hysterectomy in a Tertiary Care Hospital in the Last Three Years

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Open Journal of Obstetrics and Gynecology 2018年第11期8卷 1006-1014页

作者： Afroz Sayma Gulshan Ara Department of Obstetrics & Gynaecology Enam Medical College & Hospital Savar Bangladesh

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.

关键词： peripartum Hysterectomy Caesarean Section Placenta Accreta

Complications of peripartum Cardiomyopathy at the Departmental University Hospital Teaching of Borgou (Benin) in 2022: About 3 Cases

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World Journal of Cardiovascular Diseases 2022年第11期12卷 514-526页

作者： Léopold Houétondji Codjo Serge Hugues Mahougnon Dohou Sèdjro Raoul Atade Fabrice Atika Hamondji Nicolas Amegan Chabi Olaniran Alphonse Biaou Kayivi Murielle Hounkponou Djidjoho Arnaud Sonou Mahouna Philippe Adjagba Marielle Dorine Soude Dominique Sacca Mèdéssè Rolande Quenum Aude Sourou Bodjrenou Martin Dèdonougbo Houenassi Cardiology Teaching and Research Unit (CNHU-HKM) Faculty of Health Sciences University of Abomey Calavi Cotonou Benin Teaching and Research Unit in Cardiology (CHUD-B/A) Faculty of Medicine University of Parakou Parakou Benin Teaching and Research Department of Gynecology and Obstetric (CHUD-B/A) Faculty of Medicine University of Parakou Parakou Benin Doctoral School of Health Sciences University of Abomey Calavi Cotonou Benin Regional Institute of Public Health University of Abomey Calavi Cotonou Benin Cardiology Teaching and 6 Research Unit (CHU-MEL) Faculty of Health Sciences University of Abomey Calavi Cotonou Benin Cardiology Department of Atacora-Donga Department Hospital Center (CHD-A/D) Natitingou Benin Teaching and Research Unit in Cardiology Faculty of Medicine (CHU-OP) University of Abomey Calavi Cotonou Benin

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.

关键词： Cardiomyopathy peripartum Complications Parakou Benin

Prevalence and Characteristics of peripartum Cardiomyopathy among Women with Cadiac Failure Referred for Echocardiography in a Tertiary Hospital in Northern Nigeria

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Journal of Biosciences and Medicines 2018年第3期6卷 95-104页

作者： Hadiza Saidu Abdulwahab Kabir Nkem Ndiche Jamila A. Yau Umar Abdullahi M. S. Mijinyawa Department of Medicine Bayero University/Murtala Muhammad Specialist Hospital Kano Nigeria Department of Family Medicine Murtala Muhammad Specialist Hospital Kano Nigeria Department of Medicine Public Health and Diagnostic Institute North-West University Kano Nigeria Department of Medicine Ahmad Sani Yariman Bakura Specialist Hospital Gusau Nigeria Department of Medicine Bayero University/Aminu Kano Teaching Hospital Kano Nigeria

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.

关键词： peripartum Cardiomyopathy Echocardiography Northern Nigeria Tertiary Hospital

Heart Disease in Pregnancy:A Special Look at peripartum Cardiomyopathy

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Cardiovascular Innovations and Applications 2019年第B2期3卷 403-408页

作者： Dmitry Yaranov,MD Jeffrey D.Alexis,MD College of Medicine University of FloridaJacksonvilleFLUSA University of Rochester RochesterNYUSA

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 *** 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 *** review discusses the epidemiology,risk factors,diagnosis,treatment and prognosis of PPCM and highlights recent advances in our understanding of this disorder.

关键词： peripartum cardiomyopathy heart failure