Maternal and Perinatal Outcome of a Pregnancy Complicated with Dilated Cardiomyopathy

Dilated cardiomyopathy (DCM) is characterized by ventricular enlargement along with left systolic cardiac dysfunction. In association with pregnancy, it has been classified as pregnancy associated DCM (PADCM) and peripartum cardiomyopathy(PPCM). Herein we report a case of 26 year old G2P1L1 presented at 27weeks of gestation with progressive dyspnea and pedal edema for last 3 weeks. Clinical features of biventricular failure were present. 2D Echocardiogra-phy showed dilated cardiomyopathy, severe mitral regurgitation, ejection fraction 20-25% and mild pulmonary arterial hypertension. Based on these findings PADCM was diagnosed as there was no history of prior cardiac disease. She was started on drugs carvedilol, amiadrone and frusemide along with fluid restriction and strict input/output monitoring. Pregnancy continued till 35 weeks of gestation and then terminated by LSCS. Post-delivery she again landed up in bi-ventricular failure, managed in ICU with carditonic drugs and ventilator support. She recovered after 5 days of intensive care. Pregnancy in women with DCM is at high risk of adverse maternal and perinatal outcome. However early involvement of cardiologist and obstetrician in the management of such cases improves the maternal and fetal outcome. This case report addresses the challenges that pregnancy complicated with DCM poses on the obstetrician.

Keywords: Heart failure, pregnancy associated dilated cardiomyopathy, peripartum cardiomyopathy