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1.
BMC Cardiovasc Disord ; 24(1): 243, 2024 May 09.
Article En | MEDLINE | ID: mdl-38724901

BACKGROUND: The aim of this study was to evaluate the recovery rate of the left ventricular systolic function of women diagnosed with peripartum cardiomyopathy receiving specialized care in rural Tanzania. METHODS: In this observational study, women diagnosed with peripartum cardiomyopathy at a referral center in rural Tanzania between December 2015 and September 2021 were included. Women diagnosed between February and September 2021 were followed prospectively, those diagnosed between December 2015 and January 2021 were tracked back for a follow-up echocardiography. All participants received a clinical examination, a comprehensive echocardiogram, and a prescription of guideline-directed medical therapy. The primary outcome was recovery of the left ventricular systolic function (left ventricular ejection fraction > 50%). RESULTS: Median age of the 110 participants was 28.5 years (range 17-45). At enrolment, 49 (45%) participants were already on cardiac medication, 50 (45%) had severe eccentric hypertrophy of the left ventricle, and the median left ventricular ejection fraction was 30% (range 15-46). After a median follow-up of 8.98 months (IQR 5.72-29.37), 61 (55%) participants were still on cardiac medication. Full recovery of the left ventricular systolic function was diagnosed in 76 (69%, 95% CI 59.6-77.6%) participants. In the multivariate analysis, a higher left ventricular ejection fraction at baseline was positively associated with full recovery (each 5% increase; OR 1.7, 95% CI 1.10-2.62, p = 0.012), while higher age was inversely associated (each 10 years increase; OR 0.40, 95% CI 0.19-0.82, p = 0.012). CONCLUSION: Left ventricular systolic function recovered completely in 69% of study participants with peripartum cardiomyopathy from rural Tanzania under specialized care.


Cardiomyopathies , Peripartum Period , Pregnancy Complications, Cardiovascular , Recovery of Function , Stroke Volume , Systole , Ventricular Function, Left , Humans , Female , Adult , Tanzania/epidemiology , Young Adult , Adolescent , Pregnancy , Cardiomyopathies/physiopathology , Cardiomyopathies/diagnostic imaging , Cardiomyopathies/diagnosis , Time Factors , Middle Aged , Pregnancy Complications, Cardiovascular/physiopathology , Pregnancy Complications, Cardiovascular/diagnostic imaging , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/drug therapy , Treatment Outcome , Prospective Studies , Rural Health , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/diagnosis , Puerperal Disorders/physiopathology , Puerperal Disorders/diagnosis , Puerperal Disorders/therapy , Puerperal Disorders/drug therapy
2.
BMC Pregnancy Childbirth ; 24(1): 358, 2024 May 14.
Article En | MEDLINE | ID: mdl-38745136

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are the most common cause of postpartum readmission. Prior research led to clinical guidelines for postpartum management; however, the patient experience is often missing from this work. The objective of this study is to understand the perspective of patients readmitted for postpartum hypertension. METHODS: This was a qualitative study with data generated through semi-structured interviews. Patients readmitted with postpartum HDP at an urban academic medical center from February to December 2022 were approached and consented for an interview. The same researcher conducted all interviews and patient recruitment continued until thematic saturation was reached (n = 9). Two coders coded all interviews using Nvivo software with both deductive and inductive coding processes. Discrepancies were discussed and resolved with consensus among the two coders. Themes were identified through an initial a priori template of codes which were expanded upon using grounded theory, and researchers were reflexive in their thematic generation. RESULTS: Six themes were generated: every pregnancy is different, symptoms of preeclampsia are easily dismissed or minimized by both patient and providers, miscommunication regarding medical changes can increase the risk of readmissions, postpartum care coordination and readmission logistics at our hospital could be improved to facilitate caring for a newborn, postpartum care is often considered separately from the rest of pregnancy, and patient well-being improved when conversations acknowledged the struggles of readmission. CONCLUSIONS: This qualitative research study revealed patient-identified gaps in care that may have led to readmission for hypertensive disorders of pregnancy. The specific recommendations that emerge from these themes include addressing barriers to blood pressure management prior to discharge, improving postpartum discharge follow-up, providing newborn care coordination, and improving counseling on the risk of postpartum preeclampsia during discharge. Incorporating these patient perspectives in hospital discharge policy can be helpful in creating patient-centered systems of care and may help reduce rates of readmission.


Patient Readmission , Postpartum Period , Qualitative Research , Humans , Female , Patient Readmission/statistics & numerical data , Pregnancy , Adult , Postpartum Period/psychology , Hypertension, Pregnancy-Induced/therapy , Puerperal Disorders/therapy , Puerperal Disorders/psychology , Postnatal Care/methods , Interviews as Topic
5.
Eur Heart J ; 45(20): 1831-1839, 2024 May 27.
Article En | MEDLINE | ID: mdl-38740526

BACKGROUND AND AIMS: Arrhythmic mitral valve prolapse (AMVP) is linked to life-threatening ventricular arrhythmias (VAs), and young women are considered at high risk. Cases of AMVP in women with malignant VA during pregnancy have emerged, but the arrhythmic risk during pregnancy is unknown. The authors aimed to describe features of women with high-risk AMVP who developed malignant VA during the perinatal period and to assess if pregnancy and the postpartum period were associated with a higher risk of malignant VA. METHODS: This retrospective international multi-centre case series included high-risk women with AMVP who experienced malignant VA and at least one pregnancy. Malignant VA included ventricular fibrillation, sustained ventricular tachycardia, or appropriate shock from an implantable cardioverter defibrillator. The authors compared the incidence of malignant VA in non-pregnant periods and perinatal period; the latter defined as occurring during pregnancy and within 6 months after delivery. RESULTS: The authors included 18 women with AMVP from 11 centres. During 7.5 (interquartile range 5.8-16.6) years of follow-up, 37 malignant VAs occurred, of which 18 were pregnancy related occurring in 13 (72%) unique patients. Pregnancy and 6 months after delivery showed increased incidence rate of malignant VA compared to the non-pregnancy period (univariate incidence rate ratio 2.66, 95% confidence interval 1.23-5.76). CONCLUSIONS: The perinatal period could impose increased risk of malignant VA in women with high-risk AMVP. The data may provide general guidance for pre-conception counselling and for nuanced shared decision-making between patients and clinicians.


Mitral Valve Prolapse , Pregnancy Complications, Cardiovascular , Humans , Female , Pregnancy , Mitral Valve Prolapse/complications , Mitral Valve Prolapse/epidemiology , Retrospective Studies , Adult , Pregnancy Complications, Cardiovascular/epidemiology , Risk Factors , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/etiology , Tachycardia, Ventricular/epidemiology , Tachycardia, Ventricular/etiology , Puerperal Disorders/epidemiology , Puerperal Disorders/etiology , Defibrillators, Implantable , Incidence , Ventricular Fibrillation/epidemiology , Ventricular Fibrillation/etiology , Postpartum Period
6.
Sci Rep ; 14(1): 8777, 2024 04 16.
Article En | MEDLINE | ID: mdl-38627585

Different diagnoses of thyroid disease are available in the 10th International Classification of Diseases (ICD-10), but the validity of diagnoses related to obstetric and postpartum thyroid disease is unknown. This was a retrospective cohort study of all patients in the North Denmark Region with a diagnosis of postpartum thyroiditis (PPT) (ICD-10: O905) from 2016 to 2019 or obstetric thyroid disease in 2019 (ICD-10: O992B (hypothyroidism) or O992C (hyperthyroidism)) registered in the Danish National Hospital Register. Information from nationwide registers and medical records were used to assess the validity. Among patients with an O905-diagnosis (n = 40), abnormal thyroid function test results were seen in all cases. A total of eight patients (20.0%) were positive for thyrotropin receptor antibodies postpartum, however, in low titers, and PPT was verified in 39 of 40 cases (97.5%). Altogether 45 of 50 patients with an O992B-diagnosis (90.0%) correctly had hypothyroidism, whereas hyperthyroidism was found in 25 of 39 patients with an O992C-diagnosis (64.1%). This is the first study to validate ICD-10 diagnoses of obstetric and postpartum thyroid disease. A high validity was seen for PPT (O905) and obstetric hypothyroidism (O992B), whereas for obstetric hyperthyroidism (O992C), the diagnosis could not be verified in one third of the cases.


Hyperthyroidism , Hypothyroidism , Puerperal Disorders , Thyroid Diseases , Pregnancy , Female , Humans , Retrospective Studies , Thyroid Diseases/diagnosis , Thyroid Diseases/epidemiology , Hypothyroidism/diagnosis , Hypothyroidism/epidemiology , Hyperthyroidism/diagnosis , Hyperthyroidism/epidemiology , Postpartum Period , Denmark/epidemiology
7.
Yale J Biol Med ; 97(1): 107-112, 2024 Mar.
Article En | MEDLINE | ID: mdl-38559459

Postpartum psychosis is a mental illness that is often misunderstood and stigmatized and can have a devastating impact on the women affected and their families, particularly when not identified and treated early on. The first-person perspective of experiencing a mental illness such as postpartum psychosis is remarkably powerful and can shed light on some of the hidden or misunderstood aspects of diagnosis, treatment, recovery, and getting support. With this in mind, we have prepared this interview from both an academic and lived experience perspective of postpartum psychosis, for clinicians, academics, mental health professionals, and members of the public.


Psychotic Disorders , Puerperal Disorders , Female , Humans , Communication , Postpartum Period/psychology , Psychotic Disorders/diagnosis , Psychotic Disorders/therapy , Psychotic Disorders/psychology , Puerperal Disorders/psychology
8.
Medicine (Baltimore) ; 103(17): e37986, 2024 Apr 26.
Article En | MEDLINE | ID: mdl-38669392

RATIONALE: Uterine inversion is a rare medical condition that is categorized as puerperal and nonpuerperal. Repositioning of uterine involution can be done manually or surgically, the latter of which involves abdominal manipulation and disruption of the integrity of the uterine wall, which can lead to complications for the patient in subsequent pregnancies, such as uterine rupture. PATIENT CONCERNS: We report a case of acute puerperal uterine inversion that was manually repositioned transvaginally. An ultrasonogram and reset schematic were also presented. A 23-year-old woman (gravida 1 para 0) was admitted to the hospital with a full-term pregnancy. DIAGNOSES: In the postpartum period, we found placental adhesions and uterine inversion into the uterine cavity, which was confirmed by bedside ultrasound. INTERVENTIONS AND OUTCOMES: We administered analgesic, relieving uterine spasms, and antishock therapy along with manual stripping of the placenta and ultrasound-guided uterine repositioning. After successful repositioning the patient vaginal bleeding decreased rapidly and she was discharged 3 days after delivery. LESSONS: Early recognition, antishock therapy and prompt repositioning are key in the management of puerperal uterine inversion. We hope that this case will enable clinicians to better visualize the ultrasound imaging of uterine inversion and the process of manual repositioning.


Uterine Inversion , Female , Humans , Pregnancy , Young Adult , Postpartum Period , Puerperal Disorders/diagnostic imaging , Puerperal Disorders/diagnosis , Puerperal Disorders/therapy , Ultrasonography/methods , Uterine Inversion/therapy , Adult
9.
N Engl J Med ; 390(15): 1443, 2024 Apr 18.
Article En | MEDLINE | ID: mdl-38631015
10.
N Engl J Med ; 390(15): 1443, 2024 Apr 18.
Article En | MEDLINE | ID: mdl-38631014
11.
Eur J Obstet Gynecol Reprod Biol ; 296: 265-269, 2024 May.
Article En | MEDLINE | ID: mdl-38490047

INTRODUCTION: Depression during pregnancy is a severe state that increases the risk of suicide, as well as adverse newborn outcomes. Selective serotonin re-uptake inhibitors (SSRIs) are effective for the treatment of depression, but increase the risk of bleeding complications at delivery. Knowledge on the dose dependency of this association is lacking. METHODS: A hospital-based cohort study of all women who gave birth at Karolinska University Hospital in Stockholm over the 5-year period from 2007 to 2011, with or without SSRI use, was undertaken. In total, 334 women who delivered vaginally and were exposed to SSRIs at delivery were identified. All other women who delivered vaginally formed the control group (n = 31,929). The electronic maternal health records of the 334 SSRI users were scrutinized, and the women were categorized into two groups: moderate (n = 246) or high (n = 88) SSRI dose at delivery. The main outcome was bleeding complications at delivery in relation to SSRI dose. RESULTS: A dose-dependent increase in the rate of postpartum haemorrhage (≥1000 ml) was found, affecting 8.4 %, 14.6 % and 23.9 % (p ≤ 0.001) of women in the control group, the moderate-dose group and the high-dose group, respectively. In addition, a dose-dependent increase in the rate of postpartum anaemia was found, affecting 7.0 %, 9.3 % and 15.9 % (p = 0.001) of women in the control group, the moderate-dose group and the high-dose group, respectively. Mean blood loss of 406 ml, 483 ml and 482 ml (p ≤ 0.001) was found in the control group, the moderate-dose group and the high-dose group, respectively. Women exposed to SSRIs delivered earlier, but did not have higher prevalence of pre-eclampsia compared with the control group. CONCLUSIONS: The dose-dependent relationship between SSRIs and bleeding complications may be clinically useful in the management of this vulnerable group of women.


Postpartum Hemorrhage , Pregnancy Complications , Puerperal Disorders , Pregnancy , Infant, Newborn , Female , Humans , Selective Serotonin Reuptake Inhibitors , Cohort Studies , Pregnancy Complications/epidemiology , Postpartum Hemorrhage/epidemiology
13.
Radiographics ; 44(4): e230164, 2024 Apr.
Article En | MEDLINE | ID: mdl-38547034

Severe obstetric hemorrhage is a leading cause of maternal mortality and morbidity worldwide. Major hemorrhage in the antepartum period presents potential risks for both the mother and the fetus. Similarly, postpartum hemorrhage (PPH) accounts for up to a quarter of maternal deaths worldwide. Potential causes of severe antepartum hemorrhage that radiologists should be familiar with include placental abruption, placenta previa, placenta accreta spectrum disorders, and vasa previa. Common causes of PPH that the authors discuss include uterine atony, puerperal genital hematomas, uterine rupture and dehiscence, retained products of conception, and vascular anomalies. Bleeding complications unique to or most frequently encountered after cesarean delivery are also enumerated, including entities such as bladder flap hematomas, rectus sheath and subfascial hemorrhage, and infectious complications of endometritis and uterine dehiscence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Javitt and Madrazo in this issue.


Postpartum Hemorrhage , Puerperal Disorders , Pregnancy , Female , Humans , Postpartum Hemorrhage/diagnostic imaging , Postpartum Hemorrhage/etiology , Postpartum Hemorrhage/surgery , Placenta , Cesarean Section , Hematoma
14.
Medicine (Baltimore) ; 103(11): e37510, 2024 Mar 15.
Article En | MEDLINE | ID: mdl-38489712

BACKGROUND: Delayed postpartum hemorrhage is rare, with an incidence of 0.5% to 2.0% in all pregnancies. The most important causes are placental remnants, infections, and placental bed subinvolution. Postpartum choriocarcinoma, a highly malignant complication of pregnancy, is a rare condition that can be easily misdiagnosed as other common causes, such as gestational remnants, and delays the diagnosis. METHODS: Four patients visited our clinic complaining of delayed postpartum hemorrhage, combined with respiratory and neurological symptoms in 2 cases. Two cases were confirmed by histopathological examination and in addition, medical history, elevated human chorionic gonadotropin (hCG) level, and imaging findings help confirm the diagnosis of delayed postpartum hemorrhage caused by postpartum choriocarcinoma in other cases. Individualized combination chemotherapies were prescribed. In the light of massive cerebral metastasis in case 2, intrathecal methotrexate injection combined with whole-brain radiotherapy was prescribed. RESULTS: Due to the absence of routine monitoring of ß-hCG following full-term delivery, there was widespread metastasis at the time of diagnosis. Three patients got complete remission and there is no sign of recurrence. One patient had relapse and widespread metastasis and died at home 6 months after the last chemotherapy. CONCLUSION: It is important to be aware of the possibility of choriocarcinoma in patients with delayed postpartum hemorrhage. Clinicians should improve the recognition of choriocarcinoma following full-term delivery, emphasize the monitoring of ß-hCG, comprehensively analyze the general condition of patients, and conduct standardized and individualized chemotherapy protocols.


Choriocarcinoma , Gestational Trophoblastic Disease , Postpartum Hemorrhage , Puerperal Disorders , Uterine Neoplasms , Humans , Pregnancy , Female , Postpartum Hemorrhage/etiology , Placenta/pathology , Uterine Neoplasms/pathology , Neoplasm Recurrence, Local/pathology , Choriocarcinoma/complications , Choriocarcinoma/diagnosis , Choriocarcinoma/drug therapy , Postpartum Period , Chorionic Gonadotropin, beta Subunit, Human , Gestational Trophoblastic Disease/pathology , Puerperal Disorders/pathology
15.
Medicine (Baltimore) ; 103(13): e37600, 2024 Mar 29.
Article En | MEDLINE | ID: mdl-38552076

RATIONALE: Peripartum cardiomyopathy (PPCM) occurring in the context of hypertension presents a unique clinical challenge. This case contributes to the medical literature by highlighting the complexities of managing heart failure in postpartum women with pre-existing hypertensive disorders, particularly when complicated by a history of preeclampsia. PATIENT CONCERNS: Mrs. O.O., a 34-year-old hypertensive woman, presented with progressive dyspnea, bilateral leg swelling, and orthopnea. Notably, she had a history of previous preeclampsia and exhibited worsening symptoms over several months. DIAGNOSES: The patient was diagnosed with decompensated heart failure secondary to PPCM, exacerbated by hypertension and anemia. INTERVENTIONS: Therapeutic interventions included diuretics, angiotensin receptor-neprilysin inhibitors, digoxin, and anticoagulation. Additionally, lifestyle modifications and dietary restrictions were implemented. OUTCOMES: Following treatment adjustments, the patient demonstrated significant improvement in symptoms, exercise tolerance, and cardiac function. The transition from NYHA class III to class II heart failure indicated successful management. LESSONS: This case underscores the importance of a comprehensive approach to managing PPCM in hypertensive patients, with attention to cardiovascular and obstetric factors. It highlights the effectiveness of multidisciplinary care in achieving positive outcomes and emphasizes the need for heightened vigilance in postpartum women with cardiovascular risk factors.


Cardiomyopathies , Heart Failure , Hypertension , Pre-Eclampsia , Pregnancy Complications, Cardiovascular , Puerperal Disorders , Pregnancy , Humans , Female , Adult , Peripartum Period , Cardiomyopathies/complications , Cardiomyopathies/therapy , Heart Failure/complications , Heart Failure/therapy , Puerperal Disorders/diagnosis , Puerperal Disorders/etiology , Puerperal Disorders/therapy , Hypertension/complications , Pregnancy Complications, Cardiovascular/therapy
16.
Curr Probl Cardiol ; 49(5): 102474, 2024 May.
Article En | MEDLINE | ID: mdl-38395115

Peripartum cardiomyopathy (PPCM) remains a significant challenge in maternal health, marked by its unpredictable onset and varied clinical outcomes. With rising incidence rates globally, understanding PPCM is vital for improving maternal care and prognosis. This review aims to consolidate current knowledge on PPCM, highlighting recent advancements in its diagnosis, management, and therapeutic approaches. This comprehensive review delves into the epidemiology of PPCM, underscoring its global impact and demographic variations. We explore the complex etiology of the condition, examining known risk factors and discussing the potential pathophysiological mechanisms, including oxidative stress and hormonal influences. The clinical presentation of PPCM, often similar yet distinct from other forms of cardiomyopathy, is analyzed to aid in differential diagnosis. Diagnostic challenges are addressed, emphasizing the role of advanced imaging and biomarkers. Current management strategies are reviewed, focusing on the absence of disease-specific treatments and the application of general heart failure protocols. The review also discusses the prognosis of PPCM, factors influencing recovery, and the implications for future pregnancies. Finally, we highlight emerging research directions and the urgent need for disease-specific therapies, aiming to provide a roadmap for future studies and improved patient care. This review serves as a crucial resource for clinicians and researchers, contributing to a deeper understanding and better management of PPCM.


Cardiomyopathies , Heart Failure , Pregnancy Complications, Cardiovascular , Puerperal Disorders , Pregnancy , Female , Humans , Peripartum Period , Cardiomyopathies/diagnosis , Cardiomyopathies/epidemiology , Cardiomyopathies/etiology , Puerperal Disorders/diagnosis , Puerperal Disorders/epidemiology , Puerperal Disorders/etiology , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/therapy , Prognosis , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/epidemiology , Pregnancy Complications, Cardiovascular/etiology
17.
Curr Opin Anaesthesiol ; 37(3): 234-238, 2024 Jun 01.
Article En | MEDLINE | ID: mdl-38390913

PURPOSE OF REVIEW: Postpartum anemia (PPA) is common in women after childbirth and affects about 50-80% of all women worldwide. Iron deficiency (ID) is the main cause for anemia and constitutes a potentially preventable condition with great impact on the mother's physical and mental condition after delivery. In most cases, PPA is associated with antenatal ID and peripartum blood losses. Numerous published studies confirmed the positive effect of PPA diagnosis and treatment. RECENT FINDINGS: Iron deficiency as well as iron deficiency anemia (IDA) are common in the postpartum period and represent significant health problems in women of reproductive age. SUMMARY: Important movements towards early detection and therapy of postpartum anemia have been observed. However, postpartum anemia management is not implemented on a large scale as many healthcare professionals are not aware of the most recent findings in the field. Diagnosis and therapy of PPA, particularly iron supplementation in ID and IDA, has proven to be highly effective with a tremendous effect on women's wellbeing and outcome.


Anemia, Iron-Deficiency , Humans , Female , Anemia, Iron-Deficiency/diagnosis , Anemia, Iron-Deficiency/therapy , Anemia, Iron-Deficiency/etiology , Pregnancy , Anemia/therapy , Anemia/diagnosis , Anemia/etiology , Iron/therapeutic use , Iron/administration & dosage , Postpartum Period , Puerperal Disorders/therapy , Puerperal Disorders/diagnosis , Puerperal Disorders/etiology , Dietary Supplements , Iron Deficiencies/diagnosis , Iron Deficiencies/therapy
19.
Pan Afr Med J ; 47: 6, 2024.
Article En | MEDLINE | ID: mdl-38371651

Peripartum cardiomyopathy (PPCM) is a rare and potentially life-threatening disease associated with pregnancy. There are limited data regarding the outcome of PPCM and its predictive factors in sub-Saharan African patients. We prospectively conducted a double-center (cardiology unit of the department of medicine, Regional Hospital Center of Tenkodogo, Burkina Faso and the department of cardiology of the National Referral Teaching Hospital of N´Djamena, Chad) cohort study in patients with PPCM. Patients were consecutively enrolled from January 2015 to December 2017. Outcomes of interest were left ventricular recovery and poor outcome at one year. Ninety-four patients enrolled with a median age of 28 years. At one-year follow-up, 40.5% of them recovered their left ventricular function. Cox multiple regression analysis revealed that higher left ventricle ejection fraction (LVEF), lower natremia and use of betablockers were baseline variables predicting this end-point. Of the entire study population, 26.60% exhibited the composite end-point of death (n=15) or remaining in New York Heart Association (NYHA) class III-IV or LVEF < 35%. Predictors of poor outcome were lower LVEF at baseline, hyponatremia and use of digoxin. The current cohort study demonstrated that PPCM in sub-Saharan Africa is associated with limited myocardial recovery and significant rate of poor outcome at one year. Therefore, additional studies are needed to better address the disease.


Cardiomyopathies , Pregnancy Complications, Cardiovascular , Puerperal Disorders , Pregnancy , Female , Humans , Adult , Cohort Studies , Peripartum Period , Heart Ventricles , Cardiomyopathies/epidemiology , Ventricular Function, Left , Stroke Volume
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