Pune, Sep 18: Doctors at Manipal Hospital, Baner successfully treated a high-risk pregnancy after detecting severe heart dysfunction in a woman with no previous history of cardiac disease. The 31-year-old, who was in her first pregnancy, had developed mild breathlessness, palpitations and uneasiness around the 34th week of pregnancy. Further evaluation showed severely reduced heart function, with her Left Ventricular Ejection Fraction, a measure of how effectively the heart pumps blood, was just 24%, indicating severely reduced heart function. She was admitted for close monitoring and multidisciplinary management, requiring immediate termination of pregnancy with C-section. She delivered a healthy baby girl weighing 2.6 kg.
Peripartum cardiomyopathy is a rare condition associated with pregnancy and childbirth. An Indian study reported an incidence of approximately one case per 1,541 live births. The same study found that an ejection fraction below 30% was associated with a higher risk of adverse maternal outcomes. In this case, the patient’s ejection fraction was 24%, making close monitoring and timely intervention particularly important.
Speaking about the case, Dr. Swatee Gaggare, Consultant Gynaecologist, Manipal Hospital, Baner, said,
“The patient was consulting since pre-pregnancy time & her pregnancy had been progressing normally until the she began experiencing breathlessness and a persistently high heart rate. As these symptoms can occur during the later stages of pregnancy, they initially appeared relatively mild. However, the change in her symptoms, particularly an unusual episode of breathlessness and palpitations, prompted further cardiac evaluation. A 2D Echo showed that the chambers of her heart were enlarged and the heart’s main pumping chamber was functioning very poorly, with an LVEF of just 24%. The findings suggested dilated cardiomyopathy, a condition in which the heart becomes enlarged and weakened, reducing its ability to pump blood effectively. (A 2D Echo revealed severely dilated cardiac chambers with severe left ventricular systolic dysfunction. The findings were suggestive of primary idiopathic dilated cardiomyopathy.) Then we considered pregnancy-related cardiomyopathy and planned a Cardiac MRI for further assessment. A cardiac MRI is planned for extra evaluation, and peripartum cardiomyopathy is also being diagnosed.”
Further she added,” Breathlessness and palpitations are symptoms that might appear towards the end of pregnancy, making it difficult to differentiate between common pregnancy-related changes and something more significant. In this case, the change in her symptoms and the unusual breathlessness prompted us to investigate further. The cardiac evaluation revealed a serious underlying condition that had not been diagnosed earlier. Once we understood the severity of her condition, we had to carefully balance the mother’s health with the baby‘s well-being while deciding the timing of delivery.”
Dr. Akshay Kashid, Consultant Cardiologist, Manipal Hospital, Baner, said,
“This was an unexpected finding in a patient who had otherwise experienced a routine pregnancy. With an ejection fraction (EF) of 24%, which measures how much blood the heart pumps out with each heartbeat, her heart function was significantly reduced. We therefore had to carefully weigh the risks of continuing the pregnancy. The patient was admitted to the ICU for close monitoring, and a team comprising cardiology, obstetrics, critical care and cardiac anaesthesia specialists planned her management and a decision of emergency c-section taken.
Sharing her experience, the patient said,
“A heartfelt thank you to the entire hospital team for the exceptional care, support, and compassion throughout my pregnancy, delivery, and recovery. A special thanks to Dr. Swatee, my gynaecologist, for her proactive and calm approach in understanding my case, identifying the risks at the right time, and immediately bringing together a team of experienced specialists. Her reassurance and confidence gave us immense trust and positivity throughout this journey.”
The patient was closely monitored in the ICU following the procedure and initially required oxygen support. She was given cardiac medication, including a beta blocker and diuretic, along with other supportive treatment. The mother remained stable and was discharged from the hospital on the seventh day after delivery. The baby girl was healthy after birth and did not require NICU care.
The patient continues to undergo cardiac follow-up, and a Cardiac MRI is planned to help further assess the underlying cause of her cardiomyopathy. Doctors have advised avoiding another pregnancy until her heart function has recovered and her cardiac condition has been reassessed.
The case highlights the importance of recognising new or unusual symptoms during pregnancy and seeking timely medical treatment. While breathlessness and palpitations can occur during the later stages of pregnancy, a sudden change or worsening of symptoms should not be overlooked. Early evaluation can help identify serious underlying conditions and allow appropriate care to be planned for both the mother and baby.