Team-based approach key to care in peripartum cardiomyopathy.(Obstetrics)

ASHEVILLE, N.C. -- Focus on the woman's health in those rare cases of peripartum cardiomyopathy, said Thomas S. Ivester, M.D., at the Southern Obstetric and Gynecologic Seminar. "Maternal health is of paramount importance in this situation," Dr. Ivester, of the department of maternal-fetal medicine said during the University of North Carolina at Chapel Hill.

Cardiomyopathy is an infrequent but potentially fatal complication of pregnancy. The mortality rate is 0.4 per 100,000 live births. Risk factors during pregnancy include multiparity, advanced age, African American race, and preeclampsia.

Care of critically ill pregnant women requires a team-based approach, with good communication among caregivers and specialists. Obstetricians can serve a vital role in educating critical care colleagues about treating pregnant patients who are critically ill.

In particular, "cardiac indices and central venous pressure are notoriously inaccurate in critically ill gravida. This is especially so with preeclampsia," said Dr. Ivester. Use echocardiography to assess volume or use a P.A. catheter to get a wedge pressure.

Fetal decompensation is frequently a warning sign of subsequent significant maternal decompensation. "Once it's detected, cardiac monitoring of the fetus should probably be ceased until the mom is completely stabilized. Intervention in that scenario is probably ill advised," said Dr. Ivester.

In patients who have significant hemorrhage or in those who may have suffered some type of hypovolemic insult or have been in shock, dopamine can be used to preserve and enhance renal and placental perfusion. "So a renal dose of dopamine, you can also consider as a placental dose of dopamine," Dr. Ivester said.

Whenever possible, delivery should be reserved for obstetric indications. Vaginal delivery is preferred, because it is tolerated better by the woman. These patients should have prophylaxis for deep vein thrombosis, which can be accomplished by mechanical ...