PERIPARTUM CARDIOMYOPATHY. Situations.

You have echocardiographic findings of borderline left ventricular dilatation, mildly reduced LV systolic function (EF 46%), mild mitral regurgitation, mild-to-moderate tricuspid regurgitation, and mildly elevated pulmonary artery pressure (PAP 43 mmHg). These findings suggest early peripartum cardiomyopathy

Urgent evaluation by a cardiologist and high-risk obstetric team is recommended before delivery. Assess for symptoms and signs of heart failure, including dyspnea at rest, orthopnea, paroxysmal nocturnal dyspnea, edema, and oxygen desaturation. Caesarean delivery should be planned based on obstetric indications and the overall cardiac assessment. If clinically stable, vaginal delivery may be feasible; the delivery route should be individualized by the multidisciplinary team. If caesarean delivery is required, appropriate anesthetic planning, careful fluid management, and maternal hemodynamic monitoring are essential. Arrange postpartum cardiac monitoring and follow-up echocardiography, as cardiac deterioration can occur in the early postpartum period.

An EF of 46% indicates mildly reduced LV systolic function and should not be dismissed as a normal physiological change of pregnancy. However, it does not by itself establish peripartum cardiomyopathy, which classically involves an LVEF below 45% after exclusion of other causes. Maternal risk cannot be determined from the echocardiogram alone; urgent multidisciplinary assessment is necessary to establish the safest delivery and monitoring plan. Breathlessness at rest, chest pain, syncope, worsening orthopnea, or rapidly increasing edema requires immediate hospital

Your echo shows that your heart's pumping function is mildly reduced (EF 46%), with mild leakage of some heart valves and a mild increase in lung artery pressure. These findings do not automatically mean that delivery will be dangerous, and many women can undergo delivery safely with appropriate monitoring. However, pregnancy puts extra workload on the heart, particularly around delivery and immediately after childbirth.

Therefore, we recommend a cardiology review and an anaesthesia assessment before the planned C-section. Your blood pressure, oxygen level, symptoms and heart function will be assessed to decide the safest delivery plan. If you develop breathlessness at rest, difficulty lying flat, chest pain, fainting or rapidly increasing swelling, please go to the hospital immediately. With careful planning and monitoring, we can reduce the risks to both mother and baby.

Breathlessness: Sudden/worsening breathlessness, difficulty lying flat, or waking up gasping. Cardiac symptoms: Chest pain, persistent rapid heartbeat, dizziness or fainting. Fluid overload: Rapid weight gain, increasing leg swelling or reduced urine output. Obstetric danger signs: Reduced fetal movements, vaginal bleeding, severe headache or blurred vision. If any of these occur, seek immediate hospital evaluation.