Peripartum cardiomyopathy complicating major postpartum haemorrhage with pre-eclampsia and HELLP syndrome

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Peripartum cardiomyopathy complicating major postpartum haemorrhage with pre-eclampsia and HELLP syndrome (n=1). Intervention: Multidisciplinary resuscitation, urgent transthoracic echocardiography, bisoprolol, and ramipril. Primary outcome: Ventricular function recovery on cardiac magnetic resonance imaging at 6 weeks.

Q: What does this research mean for the field?

Multidisciplinary resuscitation and medical heart failure therapy can lead to complete recovery of severe biventricular dysfunction in acute peripartum cardiomyopathy complicated by postpartum haemorrhage, pre-eclampsia, and HELLP syndrome. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ahmed Ali Kindawi; Shamma Al‐Inizi

doi:10.18203/2320-1770.ijrcog20264015

October 29, 2026International Journal of Reproduction Contraception Obstetrics and GynecologyOpen Access

Peripartum cardiomyopathy complicating major postpartum haemorrhage with pre-eclampsia and HELLP syndrome

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Key result

Multidisciplinary resuscitation and GDMT achieve complete LVEF recovery at 6 weeks in severe peripartum cardiomyopathy.

n=1

Why the study?

Diagnosing peripartum cardiomyopathy can be challenging because obstetric emergencies may provide differing explanations for cardiovascular collapse, and managing two serious medical emergencies concurrently poses clinical challenges.

Key Points

To report a rare case of acute severe biventricular failure following emergency Caesarean delivery complicated by HELLP syndrome, post-partum pre-eclampsia, and severe postpartum haemorrhage, emphasizing the diagnostic role of urgent echocardiography.
Clinical case evaluation of a 38-year-old primigravida at 38 weeks gestation undergoing emergency Caesarean section complicated by major postpartum haemorrhage and cardiovascular collapse.
Multidisciplinary diagnostic workup and stabilization involving bedside transthoracic echocardiography, Bakri balloon tamponade, blood transfusion, critical care support, and follow-up cardiac magnetic resonance imaging.
The patient developed major postpartum haemorrhage requiring Bakri balloon tamponade with 4 units of blood transfused, followed by hypotension and a peri-arrest event requiring adrenaline and transfer to the coronary care unit.
Urgent transthoracic echocardiogram demonstrated severe biventricular systolic impairment with a left ventricular ejection fraction of 20% and no structural or valvular abnormality.
Following medical therapy with bisoprolol and ramipril, cardiac magnetic resonance imaging at six weeks demonstrated normal ventricular function with sustained recovery.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 38-year-old primigravida with Type 1 diabetes in the United Kingdom who developed acute peripartum cardiomyopathy (LVEF 20%) following emergency Caesarean section, major postpartum haemorrhage, pre-eclampsia, and HELLP syndrome, followed for 6 weeks.

I

Intervention

Urgent resuscitation with adrenaline, Bakri balloon tamponade with 4 units of blood transfused, intensive-care stabilisation, and initiation of heart failure therapy with bisoprolol and ramipril

O

Outcome

Clinical and ventricular recovery (assessed by cardiac magnetic resonance imaging at six weeks)

Limitations

Single patient case report
Coexisting conditions (severe pre-eclampsia, massive postpartum haemorrhage, and HELLP syndrome) also affected acute myocardial dysfunction

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Implication

This case highlights the critical diagnostic value of urgent bedside echocardiography and multidisciplinary management in achieving full ventricular recovery for a patient with acute peripartum cardiomyopathy masked by concurrent major postpartum haemorrhage, pre-eclampsia, and HELLP syndrome.

Abstract

Peripartum Cardiomyopathy (PPCM) is a rare, potentially life-threatening cause of heart failure, developing in the later stages of pregnancy, or immediately postpartum. Diagnosis can become challenging as obstetric emergencies may provide differing explanations for cardiovascular collapse. We demonstrate a rare case of acute severe biventricular failure occurring very soon after an emergency Caesarean section for a pregnancy complicated by HELLP syndrome in the setting of post-partum pre-eclampsia and severe postpartum haemorrhage. The diagnostic value of an urgent echocardiogram in an obstetric emergency is underlined and the challenges faced by clinicians in managing two serious medical emergencies at the same time are highlighted.

Discussion

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Cite This Study

Kindawi et al. (2026) conducted a case report in Peripartum cardiomyopathy complicating major postpartum haemorrhage with pre-eclampsia and HELLP syndrome (n=1). Multidisciplinary resuscitation, urgent transthoracic echocardiography, bisoprolol, and ramipril was evaluated on Ventricular function recovery on cardiac magnetic resonance imaging at 6 weeks.

synapsesocial.com/papers/6ae585344c46c197bbab390b https://doi.org/10.18203/2320-1770.ijrcog20264015

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Peripartum cardiomyopathy complicating major postpartum haemorrhage with pre-eclampsia and HELLP syndrome

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Peripartum cardiomyopathy complicating major postpartum haemorrhage with pre-eclampsia and HELLP syndrome

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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