Peripartum cardiomyopathy: postpartum decompensation and use of non-invasive cardiac output monitoring.

Abstract

The utility of a non-invasive cardiac output monitor (NICOM™) in guiding the peripartum management and identification of postpartum complications in a patient with severe peripartum cardiomyopathy is reported. A 31-year-old nulliparous woman at 35 weeks of gestation presented with a three-week history of worsening dyspnea and progressive functional deterioration. A transthoracic echocardiogram showed severe left ventricular systolic dysfunction with an ejection fraction <20%. Cardiac status was monitored using NICOM™ during labor and delivery. The baseline values were: cardiac output 5.3 L/min, total peripheral resistance 1549 dynes.sec/cm(5), stroke volume 42.1 mL and stroke volume variation 18%. She received early epidural analgesia during labor, titrated slowly with a loading dose of 0.0625% bupivacaine 10 mL and fentanyl 25 μg, followed by patient-controlled epidural analgesia (0.0625% bupivacaine with fentanyl 2 μg/mL, infusion at 10 mL/h, bolus dose 5 mL and lockout interval 10 min). After epidural drug administration, total peripheral resistance decreased, cardiac output increased, and satisfactory analgesia was obtained. She had an uneventful vaginal delivery with a forceps-assisted second stage after prophylactic administration of furosemide 20 mg. NICOM™ was discontinued after delivery. Fifteen hours post-delivery, the patient developed cardiogenic shock, which resolved after aggressive therapy with inotropes and furosemide. NICOM™ can be used to guide treatment during labor and delivery in patients with critical peripartum cardiomyopathy. We suggest that use of NICOM™ be extended into the postpartum period to detect signs of cardiac decompensation in such patients.

• Authors: G Lorello, J Cubillos, M McDonald, M Balki
• Journal: International journal of obstetric anesthesia (Int J Obstet Anesth) Vol. 23 Issue 1 Pg. 66-70 (Feb 2014) ISSN: 1532-3374 [Electronic] Netherlands
• PMID: 24360329 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2013 Elsevier Ltd. All rights reserved.

Chemical References

• Cardiotonic Agents
• Diuretics
• Furosemide

Topics

• Adult
• Cardiac Output
• Cardiomyopathy, Dilated (complications, diagnosis, drug therapy)
• Cardiotonic Agents (therapeutic use)
• Delivery, Obstetric
• Diuretics (therapeutic use)
• Female
• Furosemide (therapeutic use)
• Humans
• Monitoring, Physiologic (methods)
• Peripartum Period
• Postpartum Period
• Pregnancy
• Shock, Cardiogenic (complications, diagnosis, drug therapy)