Peripartum Cardiomyopathy: A Case Series of Diverse Presentations and Perioperative Anesthetic Challenges in a Tertiary Hospital in South Chennai

Background Peripartum cardiomyopathy is a rare but life-threatening dilated cardiomyopathy occurring in the final month of pregnancy or within 5 months postpartum, characterized by left ventricular systolic dysfunction (ejection fraction <45%) in the absence of other identifiable causes. It poses unique diagnostic and perioperative challenges, particularly in resource-constrained settings. Objective To describe the clinical presentations, anesthetic and perioperative management strategies, and maternal outcomes of four cases of peripartum cardiomyopathy managed at a tertiary hospital in South Chennai, India. Methods A retrospective case series of four patients diagnosed with peripartum cardiomyopathy between 2022 and 2024 at a tertiary care hospital in South Chennai. Cases were identified based on established diagnostic criteria (European Society of Cardiology guidelines), and clinical data were extracted from institutional medical records following ethics committee waiver and patient consent. Results The four cases demonstrate heterogeneous presentations: one patient (Case 1) suffered fatal intraoperative cardiogenic shock during elective cesarean section with an intraoperative left ventricular ejection fraction of 25%, despite prior echocardiogram being normal. The remaining three patients achieved full left ventricular recovery within 1-3 months postpartum following tailored pharmacological therapy, including diuretics, beta-blockers, and angiotensin-converting enzyme inhibitors. Epidural analgesia was employed successfully in one case to maintain hemodynamic stability during vaginal delivery. Echocardiographic monitoring and multidisciplinary coordination were central to favorable outcomes. Conclusion This case series highlights the spectrum of peripartum cardiomyopathy presentations and the critical role of anesthetic planning, echocardiographic surveillance, and multidisciplinary care in improving maternal outcomes. Predelivery echocardiography in high-risk patients and preference for regional anesthesia techniques with careful hemodynamic monitoring are recommended in tertiary centers with resource constraints.