Triple threat: Anesthetic approach to IVF twin gestation, pre-eclampsia and peripartum cardiomyopathy in caesarean section

Peripartum cardiomyopathy (PPCM) is a rare idiopathic condition frequently presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery. Can present as acute life-threatening pulmonary oedema in late pregnancy or early puerperium, its diagnosis is mainly by exclusion of other causes of cardiac dysfunction. Anaesthetic management of such cases poses a challenge; due to the increased risk of various perioperative complications. Morbidity is high due to the reduced physiological reserve in pregnancy. PPCM and severe pre-eclampsia can co-exist and their clinical presentation may overlap, making the diagnosis more difficult and often delayed, with potentially devastating consequences. We report the successful anaesthetic management of lower segment caesarean section in a patient with PPCM with preeclampsia of IVF twin gestation.