Epidemiologic profile of peripartum cardiomyopathy in a tertiary care hospital

Abstract

Background: An epidemiologic link between peripartum cardiomyopathy (PPCM) and customary puerperal practices have been described among Nigerians. It is not, however, known if these practices have changed and influenced the epidemiology of PPCM over the years.

Objectives: To describe the current epidemiologic profile of PPCM.

Methods: Cross sectional analysis of prospectively recruited 65 patients with PPCM seen from January 2003 to December 2005 in a tertiary care hospital in Sokoto, northwest Nigeria.

Results: Incidence rate was one case per 102 deliveries. Peripartum cardiomyopathy (PPCM) constituted 2.4% of total medical admissions, 32.5% of overall admissions for heart failure, and 60% of admissions for heart failure in females. Patients were predominantly (84.6%) of Hausa and Fulani ethnic groups; and 20 (30.8%) were primiparous and 45 (69.2%) were multiparous women aged 28.2 +/- 8.1 years (range 15-45 years). Literacy rate was 6.2%. Sixty-one (93.8%) patients belonged to the low socioeconomic class. All patients presented during the postpartum period; the interval between delivery and presentation was 6.7 +/- 10.3 weeks (range .25-40 weeks, median 4 weeks). Customary puerperal practices were observed in 53 (81.5%). Hospital admission peaked during the peaks of cold harmattan and rainy seasons. Transient hypertension occurred in 18 (27.7%) patients. Complications included pericardial effusion (13.5%), intracardiac thrombosis (12.3%), and atrial fibrillation (3.1%). Stroke, pulmonary embolism, and acute lower extremity arterial occlusion each occurred in one (1.5%) patient. Mortality rate was 12.3%. Compared to the survivors, the deceased had significantly lower diastolic pressure (67.5 +/- 10.4 mm Hg vs 83.4 +/- 19.4 mm Hg; P = .04) and higher cardiothoracic index (70.2% +/- 14.4% vs 60.9% +/- 5.5%; P = .007). The outcome of PPCM correlated with cardiothoracic index (r = .7; P = .007), ejection fraction (r = .5; P = .03), and diastolic blood pressure (r = .4; P = .04).

Conclusions: The epidemiologic profile of PPCM has not changed among the ethnic Hausa and Fulani groups of northwest Nigeria. Peripartum cardiomyopathy (PPCM) is an important cause of maternal morbidity and mortality in this population.