Peripartum cardiomyopathy presents as left ventricular systolic dysfunction (ejection fraction typically <45%) in the last month of pregnancy or up to five months postpartum, in the absence of other identifiable causes. It contributes to cardiac disease remaining a leading indirect cause of maternal mortality in the UK.
Physiological context
Pregnancy induces significant cardiovascular adaptations, including increased blood volume and cardiac output. These changes can mask early decompensation. Postnatally, fluid shifts and the demands of recovery and newborn care add complexity. Symptoms such as dyspnoea, orthopnoea, oedema, and palpitations require careful differentiation from normal peripartum physiology.
Diagnostic approach
A high index of suspicion is required. National confidential enquiries repeatedly identify missed opportunities where symptoms were attributed to normal pregnancy or postnatal changes. Assessment should include:
- Detailed history focusing on symptom onset, severity, and risk factors (e.g., older maternal age, multiparity, hypertension, Black ethnicity).
- Serial observations using pregnancy-adapted early warning scores.
- Investigations: ECG, chest X-ray, natriuretic peptides (NT-proBNP), troponin, and urgent echocardiography.
- Exclusion of differentials including pulmonary embolism, infection, pre-eclampsia complications, and other cardiomyopathies.
Management
Multidisciplinary input via Maternal Medicine Networks is recommended, involving obstetrics, cardiology, and anaesthetics.
Treatment follows heart failure guidelines adapted for pregnancy and lactation, with careful medication choices (e.g., beta-blockers, hydralazine, diuretics).
Delivery planning and postnatal monitoring are critical. Long-term follow-up is essential given variable recovery rates and recurrence risks in future pregnancies.
System challenges observed
Inconsistencies in escalation pathways, variable use of early warning scores outside maternity settings, and communication gaps between teams feature in HSSIB and MBRRACE analyses. Digital triage tools may not adequately account for postnatal physiology.
Clinicians should prioritise listening to women’s accounts of symptom severity, particularly when repeated presentations occur. Joint obstetric-cardiology clinics and safety bundles support improved recognition.
Reflective questions for practice
- How consistently are pregnancy-adapted tools applied across emergency and primary care?
- Are discharge summaries reliably flagging cardiac risk factors?
- What local pathways support rapid specialist review?
This article links to broader project discussions on maternal deterioration, clinical listening, and sex-specific cardiovascular considerations.
References
- MBRRACE-UK reports. https://www.npeu.ox.ac.uk/mbrrace-uk
- NICE Acute Heart Failure guidance. https://www.nice.org.uk
- NHS England Maternal Medicine Networks service specification.
- ESC and UK position statements on PPCM.
- HSSIB national investigations.
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© 2026 Women’s Health Inquiry Project (WHIP). This article includes original analysis of material from publicly available national sources. It may not be reproduced without permission.