Interventions for treating pregnant women or new mothers with heart failure of unknown cause (peripartum cardiomyopathy)

Very rarely, some women suffer from heart failure (without any known cause) in late pregnancy or as a new mother. The heart muscle becomes large and weakened, and is unable to pump blood properly round the body. This affects the lungs, liver, and other body systems. Symptoms include: difficulty in breathing, shortness of breath, the heart racing or skipping beats. There can also be chest pain, swelling, and excessive weight gain during the last month of pregnancy. Women need to be cared for in intensive care wards. Labour is often medically induced earlier than normal if the problem arises late in pregnancy. These babies then suffer the problems of being born too early (prematurely). This review looked at interventions which might reduce harm for women with this condition The interventions included drugs, heart or blood monitoring, supportive therapies and heart transplants. We found only one pilot study, involving 20 women with heart failure after giving birth, that looked at bromocriptine given over a period of eight weeks. There were not enough data to provide a clear answer on the number of mothers dying, but the drug looked promising. Biochemical measurements were also made. Women need to be informed that the drug stops the production of breastmilk, making breastfeeding impossible. We found no trials on other possible interventions. Large trials are needed to decide the best treatment for these women and their babies.

Authors' conclusions: 

There are insufficient data to draw any firm conclusions. Treatment with bromocriptine appears promising, although women would be unable to breastfeed due to suppression of lactation.

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Background: 

Peripartum cardiomyopathy (PPCM or PCMO) is a rare disease of unknown etiology, characterised by an acute onset of heart failure in women in the late stage of pregnancy or in the early months postpartum.

Objectives: 

To assess the effectiveness and safety of any intervention for the care of women and/or their babies with a diagnosis of peripartum cardiomyopathy.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27 July 2010) and the reference lists of identified studies.

Selection criteria: 

Randomised and quasi-randomised controlled trials of any intervention for treating peripartum cardiomyopathy. Such interventions include: drugs; cardiac monitoring and treatment; haemodynamic monitoring and treatments; supportive therapies and heart transplant.

Data collection and analysis: 

Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data entry was checked.

Main results: 

We identified and included one pilot study, involving 20 women, undertaken in South Africa. Women were diagnosed postnatally and included in the study within 24 hours of diagnosis.

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