Monitoring a post-PPCM pregnancy:
- Echocardiogram each trimester and postpartum
- Plasma BNP each trimester and postpartum (rising levels
hours to days before clinical heart failure)
- Physical exam for signs and symptoms each trimester and
- Self-test for pregnancy-associated heart failure each
trimester and postpartum
NOTE: We are in initial phases of a post-PPCM pregnancy study that will help to identify who is at greatest risk for relapse of heart failure in a post-PPCM pregnancy and who has the least risk for relapse. This study should be underway in 2016-2017. Watch for further notice.
Fett JD, Christie LG, Murphy JG. Outcomes of subsequent pregnancy
after peripartum cardiomyopathy: a case series from Haiti. Ann Int Med 2006 Jul
Fett JD, Fristoe KL, Welsh SN. Risk of heart failure relapse in
subsequent pregnancy among peripartum cardiomyopathy mothers. Int J Gynecol
Monitoring subsequent pregnancy in recovered peripartum cardiomyopathy
mothers. Critical Pathways in Cardiology 2010;9:1-3.
Fett JD, Fristoe KL, Welsh SN. Risk of heart failure relapse in subsequent pregnancy among peripartum cardiomyopathy mothers. International Journal of Gynecology & Obstetrics 2010;109:34-6.
for recognition of heart failure during or just after pregnancy:*
(difficulty breathing when lying flat): (a) None 0 points; (b) Need to elevate
head 1 point; (c) Need to elevate 45 degrees or more 2 points.
(shortness of breath on exertion): (a) None 0 points; (b) Climbing 8 or more steps 1 point; (c) Walking on level 2 points.
cough: (a) None 0 points; (b) At night 1 point; (c) Day and night 2 points.
(pitting edema) lower extremities: (a) None 0 points; (b) Below knee 1 point; (c) Above and below knee 2
weight gain during last month of pregnancy: (a) Under 2 pounds per week0 points; (b) 2 to 4 pounds per week1 point; (c)
Over 4 pounds per week 2 points.
- Palpitations (sensation of irregular heart beats): (a)
None 0 points; (b) When
lying down at night 1 point; (c) Day
and night, any position 2 points.
ACTION: 5 or more points = see cardiologist re: plasma BNP and echocardiogram. Score of 5 or more has always been associated with decreased LVEF (so far).
JD. Validation of a self-test for
early diagnosis of heart failure in peripartum cardiomyopathy. Crit Pathw Cardiol 2011;10 (Mar):44-45.