Monday, November 7, 2011

Ask Us Anything: Will Cardiomyopathy Come Back?

"After my first child was born, I found out that I had Postpartum Cardiomyopathy.

After 3 years, my ejection fraction went back to normal, and I got pregnant with my second child. Things stayed the same. What are the chances of it coming back with a third pregnancy?

Could I have a vaginal delivery after two C-sections? Would a doctor support my decision if I was to try for a third?"

Dr. Bruce Rodgers Responds:

Peripartum or Postpartum Cardiomyopathy is a weakened heart diagnosed within the final months of pregnancy or within five months after delivery.

If you have had a prior pregnancy complicated by Cardiomyopathy, subsequent pregnancies do impose an increased risk, even if the left ventricular function (ejection fraction) returns to normal.

The risk of recurrent Cardiomyopathy may be as high as 20% in a subsequent pregnancy; if this occurs, the chances of the ejection fraction recovering are lower than they were in the first pregnancy. This is especially true if the ejection fraction was less than 25% in the first pregnancy in which the Cardiomyopathy occurred.

In addition, even if heart failure does not occur in a subsequent pregnancy, there may be a reduction in your left ventricular function (ejection fraction) that may be permanent. Effects may range from mildly reduced exercise tolerance to more serious symptoms, depending on the severity of impairment.

Decisions to have additional pregnancies should be undertaken with the understanding of the risks involved. Such a decision should not be made lightly and should be made in concert with your obstetrician and cardiologist, weighing the risks against the individual’s desire to have an additional child, and the impact on the individual’s family should those risks be realized.

The American Congress of Obstetricians and Gynecologists new published guidelines do allow for a “trial of labor after cesarean section (TOLAC)” after two previous Cesarean sections if certain conditions are met. From the description given, you may be a candidate. However, this decision must be made with your obstetrician, weighing the risks and benefits.

– Dr. Bruce Rodgers

Dr. Rodgers is the Director of Maternal-Fetal Medicine at Catholic Health and Director of the Fetal Testing Unit at Sisters of Charity Hospital in Buffalo.

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