Peripartum Cardiomyopathy

Emre KÖLE^* & Merve KÖLE

Bilecik State Hospital Department of Obstetrics, Gynecology Bilecik, Turkey

*Correspondence to: Dr. Emre KÖLE, Bilecik State Hospital Department of Obstetrics, Gynecology Bilecik, Turkey.

Copyright © 2018 Dr. Emre KÖLE, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction
Peripartum cardiomyopathy, which can happen in the last month of pregnancy or early postpartum, is a clinical case that can result in rare but serious complications. Presents with symptoms of heart failure. It was first described by. Demakis and colleagues [1] in 1971. Presents with symptoms of heart failure. It develops in the last prenatal month or within five months postpartum.

In this definition, it is defined as a heart failure that develops within the last month of your pregnancy or within five months after birth in the absence of an identifiable cause for the cardiac failure. In the following period, left ventricular dysfunction with ejaculation fraction reduction in echocardiography was added to the definiton [2]. Today, its etiology is not fully known. As well as spontaneous recovery, patients may also experience rapid clinical deterioration [3].

Discussion
The true incidence or prevalence peripartum cardiopathy is unknown. But in America, it is estimated to be seen in an average of 1000 to 1300 females per year [4]. Being of African descent, smoking, diabetes, hypertension, mothers over 30 years old, those who develop preeclampsia, multiple pregnancies have been associated with increased risk for developing PPCM [5]. In different studies, PPCM has been reported in 25-75% of young primigravidae [6,7].

Although researchers studying cases of familial peripartum cardiomyopathy that support genetic transmission of the disease have detected c.149A> G, p. Gln50Arg, MYH7, SCN5A, PSEN2 mutations, it should be supported by further studies [8]. Apart from that, it has been argued that relaxin hormone secreted primarily from the ovary could play a role in etiology by causing cardiac dilatation [9]. There isn’t enough study to support it. Nowadays, especially with increasing free oxygen radicals, Cathepsin D and matrix metalloproteinase, 23 KD prolactin hormone produced in fibroblasts and released from the pituitary gland, converts it to 16 KD prolactin that increases cell death. Myocyte damage, ventricular dilatation and fibrosis development resulting from endothelial cell differentiation, causes peripartum cardiopathy [5]. Improvement after bromocriptine in rats with signal transducer and transcription factor-3 mutation supports this situation [10,11]. In African patients, bromocriptine was administered 2.5 mg twice a day for 2 weeks and once a day for 6 weeks led to increase in survival [11]. Similar to heart failure, treatment is done symptomatically. In very rare cases, heart transplantation may be necessary.

Conclusion
Although it is a rare disease of unknown cause which presents during pregnancy and after delivery, peripartum cardiomyopathy is a clinical condition that causes both maternal and fetal serious complications. The goal of treatment is to improve symptoms of heart failure. Although half of the patients recover, more work is needed for the etiology and progress of the disease.

Bibliography

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