In women with a history of peripartum cardiomyopathy, subsequent pregnancy was associated with a 48.3% maternal mortality rate, which was strongly predicted by left ventricular ejection fraction at admission (AUC 0.95).
Observational (n=29)
Yes
What are the maternal and fetal outcomes of subsequent pregnancy in women with a history of peripartum cardiomyopathy, and what echocardiographic factors predict these outcomes?
Subsequent pregnancy in African women with a history of peripartum cardiomyopathy carries an extremely high risk of maternal mortality (48.3%), which is strongly predicted by reduced LVEF (<40%) and right ventricular dysfunction at admission.
Effect estimate: AUC 0.95 (95% CI 0.87-1)
p-value: p=<0.001
BACKGROUND: The aim of this study was to describe maternal and fetal outcomes after pregnancy complicated by peripartum cardiomyopathy (PPCM). METHODS: We included women that had subsequent pregnancy (SSP) after PPCM and assessed maternal prognosis and pregnancy outcomes, in-hospital up to one week after discharge. Clinical and echocardiographic data were collected comparing alive and deceased women. Factors associated with pregnancy outcomes were assessed. RESULTS: Twenty-nine patients were included, with a mean age of 26.7 ± 4.6 years and a mean gravidity number of 2.3 ± 0.5 of. At the last medical control before subsequent pregnancy, there was no congestive heart failure, the mean left ventricular diastolic diameter (LVDD) was 53 ± 4 mm and the left ventricular ejection fraction (LVEF) was ≥50% in 13 cases (44.8%). Maternal outcomes were marked by 14 deaths (48.3%). Among the factors tested in univariate analysis, LVEF at admission had an excellent receiver-operating characteristic (ROC) curve to predict maternal mortality (AUC = 0.95; 95% CI 0.87-1, p < 0.001), with a cut off value of < 40% (sensitivity = 93% and specificity = 87%). Concerning fetal outcomes, baseline LVEF had the best area under the curve (AUC) to predict abortion or prematurity among all variables (AUC = 0.75; 95% CI 0.58-092, p = 0.003), with a cut-off value of < 50% (sensitivity = 79%, specificity = 67%). CONCLUSIONS: SSP outcomes are still severe in our practice. Maternal mortality remains high and is linked to ventricular systolic function at admission (due to pregnancy), while fetal outcomes are linked to baseline LVEF before pregnancy.
Yaméogo et al. (Mon,) conducted a observational in Peripartum cardiomyopathy (n=29). Subsequent pregnancy was evaluated on Prediction of maternal mortality by LVEF at admission (AUC 0.95, 95% CI 0.87-1, p=<0.001). In women with a history of peripartum cardiomyopathy, subsequent pregnancy was associated with a 48.3% maternal mortality rate, which was strongly predicted by left ventricular ejection fraction at admission (AUC 0.95).