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[Intervention Review]

Interventions for treating peripartum cardiomyopathy to


improve outcomes for women and babies
Andrew J Carlin1, Zarko Alfirevic2, Gillian ML Gyte3
1
Maternal Fetal Medicine Unit, John Hunter Hospital, New Lambton Heights, Australia. 2School of
Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, The University
of Liverpool, Liverpool, UK. 3Cochrane Pregnancy and Childbirth Group, School of Reproductive and
Developmental Medicine, Division of Perinatal and Reproductive Medicine, The University of Liverpool,
Liverpool, UK

Contact address: Andrew J Carlin, Maternal Fetal Medicine Unit, John Hunter Hospital, Lookout Road, New
Lambton Heights, New South Wales, 2305,
Australia.andrew.carlin@hnehealth.nsw.gov.au. carlinandrew@doctors.org.uk.

Editorial group: Cochrane Pregnancy and Childbirth Group.


Publication status and date: New, published in Issue 9, 2010.
Review content assessed as up-to-date: 26 July 2010.

Citation: Carlin AJ, Alfirevic Z, Gyte GML. Interventions for treating peripartum cardiomyopathy to improve
outcomes for women and babies. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD008589.
DOI: 10.1002/14651858.CD008589.pub2.

Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Abstract
Background
Peripartum cardiomyopathy (PPCM or PCMO) is a rare disease of unknown
etiology, characterised by an acute onset of heart failure in women in the late stage
of pregnancy or in the early months postpartum.

Objectives
To assess the effectiveness and safety of any intervention for the care of women
and/or their babies with a diagnosis of peripartum cardiomyopathy.

Search strategy
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (27
July 2010) and the reference lists of identified studies.

Selection criteria
Randomised and quasi-randomised controlled trials of any intervention for treating
peripartum cardiomyopathy. Such interventions include: drugs; cardiac monitoring
and treatment; haemodynamic monitoring and treatments; supportive therapies and
heart transplant.

Data collection and analysis


Two authors independently assessed the studies for inclusion, assessed risk of bias
and carried out data extraction. Data entry was checked.

Main results
We identified and included one pilot study, involving 20 women, undertaken in
South Africa. Women were diagnosed postnatally and included in the study within
24 hours of diagnosis.

Authors' conclusions
There are insufficient data to draw any firm conclusions. Treatment with
bromocriptine appears promising, although women would be unable to breastfeed
due to suppression of lactation.

Plain language summary


Interventions for treating pregnant women or new mothers with heart failure of
unknown cause (peripartum cardiomyopathy)
Very rarely, some women suffer from heart failure (without any known cause) in
late pregnancy or as a new mother. The heart muscle becomes large and weakened,
and is unable to pump blood properly round the body. This affects the lungs, liver,
and other body systems. Symptoms include: difficulty in breathing, shortness of
breath, the heart racing or skipping beats. There can also be chest pain, swelling,
and excessive weight gain during the last month of pregnancy. Women need to be
cared for in intensive care wards. Labour is often medically induced earlier than
normal if the problem arises late in pregnancy. These babies then suffer the
problems of being born too early (prematurely). This review looked at
interventions which might reduce harm for women with this condition The
interventions included drugs, heart or blood monitoring, supportive therapies and
heart transplants. We found only one pilot study, involving 20 women with heart
failure after giving birth, that looked at bromocriptine given over a period of eight
weeks. There were not enough data to provide a clear answer on the number of
mothers dying, but the drug looked promising. Biochemical measurements were
also made. Women need to be informed that the drug stops the production of
breastmilk, making breastfeeding impossible. We found no trials on other possible
interventions. Large trials are needed to decide the best treatment for these women
and their babies.