Case records of the Massachusetts General Hospital. Case 22-2014. A 40-year-old woman with postpartum dyspnea and hypoxemia

Management of postpartum preeclampsia complicated by idiopathic pericarditis: A case report

This case report discusses the rare occurrence of pericarditis with preeclampsia in the antepartum through to postpartum state. A woman in her 30s presented four days postnatally with positional central chest pain, elevated blood pressure and newly deranged liver function tests. Echocardiogram demonstrated new pleural effusion and she was diagnosed with preeclampsia and superimposed pericarditis. Her blood pressure was stabilised with a combination treatment regime of labetalol, enalapril and frusemide, whilst her pericarditis responded well to colchicine and ibuprofen. She was eventually discharge on enalapril and colchicine. By her 6-week follow-up she had made a full recovery and she had reported no recurrence of symptoms at the time of writing.

Application of high-flow nasal cannula oxygen therapy in patient with pulmonary edema following cesarean-section under combined spinal-epidural anesthesia: A case report

BACKGROUND

High-flow nasal cannula (HFNC), which overcomes the disadvantages of the existing low flow mask, is an efficient method that can immediately provide a high volume of heated oxygen to the patient.[1] Therefore, this case reports a case in which HFNC was applied to a pregnant with acute respiratory failure.

CASE

A 37-year-old woman pregnant (GA 30 + 5 weeks) with twin was diagnosed with preeclampsia. It was decided to perform an emergency Cesarean-section under combined spinal-epidural technique worsening respiratory failure. After delivery, maternal dyspnea was not alleviated applying of O28 L/min via facial mask. Thus, high-flow nasal cannula (HFNC) oxygen therapy was applied (60 L/min, partial pressure of oxygen (FiO2) 80%) and SpO2 subsequently rose to 98% and the patient's dyspnea was resolved.

CONCLUSIONS

HFNC is a safe device that can effectively provide oxygen to pregnant with acute respiratory failure.

Peripartum Cardiomyopathy Incidence, Risk Factors, Diagnostic Criteria, Pathophysiology, and Treatment Options

Peripartum cardiomyopathy is a rare and a severe form of heart failure that affects women during pregnancy or shortly after delivery. Risk factors include advanced age, race, multiparity, multifetal pregnancy, socioeconomic disparity, and medical comorbidities including systemic hypertension, diabetes, asthma, and anemia. Peripartum cardiomyopathy is associated with increased morbidity and mortality, as well as a detrimental long-term impact on quality of life. Its etiology is not clear, although it is thought to be a combined effect of a hyperdynamic fluid state associated with pregnancy, hormonal changes unique to gestation, and a genetic predisposition. There is no current expert consensus on an optimal treatment regimen. This article will provide a comprehensive review and update on this important disease state.

Peripartum Cardiomyopathy

Peripartum cardiomyopathy is a potentially life-threatening pregnancy-associated disease that typically arises in the peripartum period and is marked by left ventricular dysfunction and heart failure. The disease is relatively uncommon, but its incidence is rising. Women often recover cardiac function, but long-lasting morbidity and mortality are not infrequent. Management of peripartum cardiomyopathy is largely limited to the same neurohormonal antagonists used in other forms of cardiomyopathy, and no proven disease-specific therapies exist yet. Research in the past decade has suggested that peripartum cardiomyopathy is caused by vascular dysfunction, triggered by late-gestational maternal hormones. Most recently, information has also indicated that many cases of peripartum cardiomyopathy have genetic underpinnings. We review here the known epidemiology, clinical presentation, and management of peripartum cardiomyopathy, as well as the current knowledge of the pathophysiology of the disease.

Molecular mechanisms of peripartum cardiomyopathy: A vascular/hormonal hypothesis

Peripartum cardiomyopathy (PPCM) is characterized by the development of systolic heart failure in the last month of pregnancy or within the first 5 months postpartum. The disease affects between 1:300 and 1:3000 births worldwide. Heart failure can resolve spontaneously but often does not. Mortality rates, like incidence, vary widely based on location, ranging from 0% to 25%. The consequences of PPCM are thus often devastating for an otherwise healthy young woman and her newborn. The cause of PPCM remains elusive. Numerous hypotheses have been proposed, with mixed supporting evidence. Recent work has suggested that PPCM is a vascular disease, triggered by the profound hormonal changes of late gestation. We focus here on these new mechanistic findings, and their potential implication for understanding and treating PPCM.