Symptoms in women with Peripartum Cardiomyopathy: A mixed method study.

OBJECTIVE: Peripartum Cardiomyopathy is a form of cardiac disease often associated with cardiac failure, occurring in late pregnancy or after childbirth. The anatomical and physiological changes in the mother associated with normal pregnancy are profound, and this may result in symptoms and signs that overlap with Peripartum Cardiomyopathy, leading to missed or delayed diagnosis. Women's experiences of Peripartum Cardiomyopathy symptoms remain poorly studied. The aim of this study was to explore and describe women's experiences of symptoms in Peripartum Cardiomyopathy. DESIGN: A triangulation of methods with individual interviews and data from medical records. SETTING: Mothers with Peripartum Cardiomyopathy diagnosis were recruited from Western Sweden as a part of research project. PARTICIPANTS: 19 women were interviewed and medical records were reviewed by authors. DATA ANALYSIS: All interview transcripts were analysed using qualitative inductive content analysis to identify key themes. RESULTS: The main theme, meaning of onset and occurrence of symptoms is captured in the metaphor: being caught in a spider web, comprising subthemes, invasion of the body by experienced symptoms and feeling of helplessness. Symptoms related to Peripartum Cardiomyopathy started for 17 women during pregnancy and in two post partum and time from symptoms to diagnosis varied between three and 190 days (median 40). The physical symptoms were:shortness of breath, excessive fatigue and swelling, bloatedness, nausea, palpitation, coughing, chest tightness, bodily pain, headache, fever, tremor, dizziness, syncope, restless and tingly body and reduced urine output. Emotional symptoms were: fear, anxiety, feelings of panic, and thoughts of impending death. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Symptoms of Peripartum Cardiomyopathy were debilitating, exhausting and frightening for the women interviewed in this study. Health care professionals responsible for the antenatal care, especially midwives, need skills to identify initial symptoms of Peripartum Cardiomyopathy for early referral and treatment by a specialist. In order to give optimal care more research is needed to show how to improve midwives' knowledge of Peripartum Cardiomyopathy.

Women's values and preferences for thromboprophylaxis during pregnancy: a comparison of direct-choice and decision analysis using patient specific utilities.

BACKGROUND: Women with a history of venous thromboembolism (VTE) have an increased recurrence risk during pregnancy. Low molecular weight heparin (LMWH) reduces this risk, but is costly, burdensome, and may increase risk of bleeding. The decision to start thromboprophylaxis during pregnancy is sensitive to women's values and preferences. Our objective was to compare women's choices using a holistic approach in which they were presented all of the relevant information (direct-choice) versus a personalized decision analysis in which a mathematical model incorporated their preferences and VTE risk to make a treatment recommendation. METHODS: Multicenter, international study. Structured interviews were on women with a history of VTE who were pregnant, planning, or considering pregnancy. Women indicated their willingness to receive thromboprophylaxis based on scenarios using personalized estimates of VTE recurrence and bleeding risks. We also obtained women's values for health outcomes using a visual analog scale. We performed individualized decision analyses for each participant and compared model recommendations to decisions made when presented with the direct-choice exercise. RESULTS: Of the 123 women in the study, the decision model recommended LMWH for 51 women and recommended against LMWH for 72 women. 12% (6/51) of women for whom the decision model recommended thromboprophylaxis chose not to take LMWH; 72% (52/72) of women for whom the decision model recommended against thromboprophylaxis chose LMWH. CONCLUSIONS: We observed a high degree of discordance between decisions in the direct-choice exercise and decision model recommendations. Although which approach best captures individuals' true values remains uncertain, personalized decision support tools presenting results based on personalized risks and values may improve decision making.

The life-changing impact of peripartum cardiomyopathy: an analysis of online postings.

BACKGROUND: Peripartum cardiomyopathy (PPCM), a form of acute heart failure, is a life-altering condition affecting thousands of pregnant or postpartum women. Little is known about the overall impact of PPCM on women's lives. PURPOSE: To describe the contents of postings made on the My Space® PPCM support group Web site by women diagnosed with PPCM. METHODS: A mixed methods design. Two hundred and forty-seven postings made by 156 people from 2005 to 2008 were copied from the Web site. Key words and phrases were sorted into categories, quantified, and then arranged into themes using the five interacting variables of the Neuman Systems Model: physiological, psychological, sociocultural, spiritual, and developmental. RESULTS: Six themes identified in the postings were discussion of symptomology, exchange of advice, interactions with healthcare providers, uncertainty about subsequent pregnancies, expressions of spirituality, and recovery from heart failure. CLINICAL IMPLICATIONS: Misdiagnosis and subsequent pregnancies were major stressors that have implications for nursing practice and future research. Nurses can help women with PPCM and their families reconstitute their lives to a new normal by providing reliable information and counseling on treatment, prognosis, and family planning.

Treatment of hypertension in pregnancy by relaxation and biofeedback.

In a study of the effectiveness of systematic relaxation training alone or combined with biofeedback in the treatment of hypertension in pregnancy, 60 women were seen weekly for 6 weeks. 18 were given relaxation therapy alone (group A), 18 relaxation plus biofeedback (group B), and there were 24 controls. Whereas two-thirds of the control group had to be admitted to hospital during their pregnancies, less than a third of each experimental group had to be admitted. The experimental groups also had significantly lower systolic and diastolic blood pressure than the control group. There were no significant differences between groups A and B in hospital admission rates or blood-pressure measurements.