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Managing pregnancy in women with pre-existing cardiomyopathies: A case series
Charo Bruce1, Claudia Montanaro1, Gurleen Wander2,3
1Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK.
Abstract:
Women with pre-existing cardiomyopathy experience high maternal and fetal complication rates when undergoing pregnancy. Different cardiomyopathy phenotypes and genetics can influence the presentation during pregnancy and help inform risk profile and management. This case series demonstrates the differing course of pregnancy in dilated, hypertrophic and arrhythmogenic cardiomyopathy. The main complications managed were arrhythmia, rising left ventricular outflow tract obstruction and heart failure. The cases highlight important pre-conception considerations, the use of biomarkers, and pharmacological and device management during pregnancy, delivery and post-partum. It is important to recognise that cardiomyopathies represent a heterogeneous group of conditions with differing phenotypes which need individualised specialist care during pregnancy. Risk stratification and management by an expert multidisciplinary team are recommended to support these women to attain good maternal and fetal outcomes.
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