Protocols for High-Risk Pregnancies, 7th Edition: Protocol 18 - Peripartum Cardiomyopathy

Peripartum cardiomyopathy and the obstetric care provider

Peripartum cardiomyopathy (PPCM) is a clinical diagnosis of exclusion defined as heart failure with a reduced ejection fraction towards the end of pregnancy or in the immediate postpartum period. This seemingly simple definition is challenged by the complexities of caring for patients in the third trimester of pregnancy and postpartum. Physiological dyspnea coupled with the other hallmark cardiovascular adaptations of pregnancy can confound the clinical presentation, and the overlap of PPCM with other obstetric and cardiovascular diagnoses further complicate the diagnostic dilemma. Despite these challenges, the increasing contribution of both cardiovascular disease and cardiomyopathy to maternal mortality highlights the importance of a framework for diagnosis and management of the disease.

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Protocol 18 - Peripartum Cardiomyopathy