Role of Antenatal 2D Echocardiography (Echo) in Predicting Peripartum Cardiomyopathy in High-Risk Pregnant Women

Background and aim Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition, and early diagnosis remains challenging due to overlap with physiological symptoms of pregnancy. Antenatal 2D echocardiography (echo) may aid in early detection, particularly in high-risk women. The present study aimed to evaluate the role of antenatal 2D echo in predicting PPCM in high-risk pregnancies and to assess associated maternal and fetal outcomes. Methods This prospective observational study was conducted on 100 high-risk pregnant women with gestational age >32 weeks at a district hospital. All participants underwent antenatal 2D echocardiographic evaluation. PPCM was diagnosed based on left ventricular ejection fraction (LVEF) <45%. Maternal and fetal outcomes were assessed. Statistical analysis was performed using the chi-square test and independent t-test, with p < 0.05 considered significant. Results PPCM was identified in 9 (9.0%) participants. Preeclampsia was the most common risk factor (41 (41.0%)) and showed a significant association with PPCM (6 (66.7%) vs 35 (38.5%), p = 0.04). All PPCM cases demonstrated reduced LVEF and left ventricular systolic dysfunction. The mean LVEF was significantly lower in the PPCM group compared to non-PPCM participants (p < 0.001). PPCM was associated with significantly adverse maternal and fetal outcomes, including higher rates of ICU admission (6 (66.7%) vs 8 (8.8%)), maternal mortality (1 (11.1%) vs 0 (0.0%)), NICU admission (4 (44.4%) vs 12 (13.2%)), intrauterine growth restriction (3 (33.3%) vs 10 (11.0%)), and prolonged hospital stay (5 (55.6%) vs 12 (13.2%)). Conclusions Antenatal 2D echo is a valuable, noninvasive modality for the early detection of PPCM in high-risk pregnancies. The present study demonstrated a significant association between PPCM and hypertensive disorders of pregnancy, particularly preeclampsia, highlighting the importance of targeted screening. Early echocardiographic identification of left ventricular systolic dysfunction facilitates timely multidisciplinary management and may help reduce adverse maternal and fetal outcomes. These findings support the incorporation of antenatal echocardiographic assessment into the routine evaluation of high-risk pregnant women, especially in resource-limited settings.