Peripartum Cardiomyopathy in Obstetric Practice: A Case Series

BACKGROUND: Peripartum cardiomyopathy is a rare but potentially life-threatening form of pregnancy-associated heart failure that occurs in the last month of pregnancy or within the first few months following delivery in women without preexisting cardiac disease. The clinical presentation often overlaps with normal physiological changes of pregnancy and the puerperium, leading to delayed diagnosis and increased maternal morbidity. Imaging modalities such as chest X-ray and echocardiography play a crucial role in early recognition and confirmation of the disease. OBJECTIVES: To describe the clinical presentation, diagnostic imaging findings, management strategies, and maternal outcomes of peripartum cardiomyopathy encountered in obstetric practice. MATERIALS AND METHODS: This case series includes five women diagnosed with peripartum cardiomyopathy and managed at a tertiary care teaching hospital over a 2-year study period from January 2024 to December 2025. Detailed clinical data, including obstetric profile, timing of presentation, symptoms of heart failure, chest X-ray findings, two-dimensional echocardiographic parameters, treatment instituted, and maternal outcomes, were collected and analyzed. Diagnosis was established based on clinical features of heart failure supported by imaging evidence of left ventricular systolic dysfunction in the absence of prior structural heart disease. RESULTS: All five women presented in the late third trimester or early postpartum period with symptoms such as breathlessness, orthopnea, fatigue, and pedal edema. Chest X-ray findings included cardiomegaly with associated pleural effusion, predominantly left-sided, in selected cases. Two-dimensional echocardiography demonstrated global left ventricular hypokinesia with reduced ejection fraction in all patients. Multidisciplinary management involving obstetricians, cardiologists, and critical care specialists was instituted. With timely diagnosis and appropriate medical management, all patients showed clinical improvement and survived the acute episode. CONCLUSION: Peripartum cardiomyopathy remains an important cause of maternal morbidity in obstetric practice. A high index of suspicion, early use of diagnostic imaging such as chest X-ray and echocardiography, and coordinated multidisciplinary management are essential for improving maternal outcomes and reducing the risk of long-term cardiac dysfunction.