Peripartum cardiomyopathy: experiences at King Edward VIII Hospital, Durban, South Africa and a review of the literature

Abstract

The clinical profile of patients with peripartum cardiomyopathy (PP-CMO) seen in the patient population in Durban, South Africa, is documented. Parameters such as age, multiparity, time of presentation and the role of hypertension in PP-CMO were evaluated. The study comprised 97 patients seen over a 4 year period. Group 1 (n = 63), had a good outcome at follow-up and group II (n = 34), had an adverse outcome, namely: persistently severe symptoms New York Hospital Association, Class III/IV; major thromboembolic complications; or a fatal outcome. These results confirm that PP-CMO is more likely to occur in the older and multiparous female. Increasing age and multiparity did not adversely affect outcome. Eighteen per cent of the study group were primiparous, and a third of these had an adverse outcome. Late presentation of symptoms (after 1 month postpartum) tended to favour an adverse outcome (P = 0.06). Fifteen of the 19 patients with complete obstetric records had antenatal hypertension: in nine blood pressure levels were > or = 160/110 mmHg. We were unable to ascertain the prognostic value of hypertension in PP-CMO. In conclusion, this study showed a high incidence of PP-CMO in the local African population (1:1000 deliveries), and a high complication rate (35%): it suggests that early diagnosis and appropriate therapy may avert an adverse outcome.