Gestational Hypertension and Peripartum Cardiomyopathy: Epidemiological, Clinical and Evolutionary Profile in the Reference Hospitals of Yaounde

Objective: Peripartum cardiomyopathy (PPCM) is a rare primary dilated cardiomyopathy responsible for congestive heart failure. Our objectives was to derermine the clinical and prognosis of PPCM et the risk factors. Design and method: We carried out a prospective descriptive study over a period of six months. It was conducted in six reference hospitals in Yaounde. The study population was made of pregnant women with dyspnoea and women who had given birth with dyspnoea. Were included all pregnant or postpartum women (from the 32nd WA to the 5th months of postpartum) who had a LVEF <45% associated or not with left ventricle dilation. They were placed on treatment with a follow-up over 3 months, where they had a second cardiac ultrasound to highlight the evolutionary profile. Results: We enrolled 10 patients from 26 women who were pregnant or had given birth and presented with dyspnoea within 6 months. The average age was 25.9 ± 4.9 years (range: 16-33 years). The average parity was 1.6 ± 1.17 (extreme 0-3). Multiparas were the most represented. The history of gestational hypertension was the main predisposing factor found (50%); followed by multiparity (30%), the notion of twin pregnancy and advanced maternal age (20%). Heart failure was the clinical expression in 60% of cases. Sinus tachycardia was constant; followed by signs of left ventricular hypertrophy and repolarization disorders on ECG assessment. The echocardiographic pattern depicted a hypokinetic dilated cardiomyopathy (mean LVEDD 61.2 ± 8.6 mm) with an average systolic function of 27.1 ± 10.6%. The main complications were acute pulmonary edema (60%), thromboembolic events including pulmonary embolism (10%), ischemic stroke (10%) and one death (10%). The treatment mostly based on the use of diuretics, ACE inhibitors, beta-blockers, Aldactone (1/3 of the patients) without forgetting the anticoagulation made with Rivaroxaban(n=4) for some and aspirin (n=6); and bromocriptine (initiated in 3 patients). Conclusions: PPCM is a cause of heart failure during pregnancy. It primarily arises during the postpartum period regardless of maternal age. It is a serious disease due to its (important morbi-mortality rate) and its complications, both hemodynamic and thromboembolic.