Clinical-socioethical approach on peripartum cardiomyopathy: a rare case report

Introduction: Peripartum cardiomyopathy (PPCM) is a rare and potentially fatal form of heart failure characterized by left ventricular dysfunction (LVEF <45%) occurring during late pregnancy or within months postpartum. Despite advances in diagnosis and treatment, PPCM often remains underrecognized, resulting in high maternal morbidity and mortality. Case: We report the case of a 21-year-old multiparous woman presenting at 39 weeks of gestation with progressive dyspnea and leg edema. She had a history of PPCM following her first pregnancy, with echocardiographic findings of LVEF 27.3% and global hypokinesia. Despite prior counseling, she discontinued treatment and conceived again. Current evaluation confirmed PPCM recurrence with LVEF 39%. She underwent cesarean section with bilateral tubectomy and was managed with bromocriptine, ACE inhibitors, beta-blockers, and diuretics. The patient's poor treatment adherence highlights the significance of long-term education and counseling. Future pregnancies in PPCM patients carry a high risk, especially with unresolved cardiac dysfunction. Contraceptive options must consider cardiac safety, thromboembolic risk, and patient compliance. In this case, permanent contraception was deemed appropriate. Conclusion: PPCM requires early diagnosis, adherence to therapy, and individualized family planning. Permanent contraception should be considered for high-risk, non-adherent patients to prevent life-threatening complications.