Peripartum cardiomyopathy and massive transfusion due to postpartum hemorrhage: was it associated with each other?
Background: Peripartum cardiomyopathy (PPCM) is a potentially life-threatening pregnancy-associated disease marked by left ventricular dysfunction and heart failure (HF). Clinical findings of HF are often masked by the normal physiological changes seen in pregnancy, making the diagnosis challenging. Furthermore, postpartum hemorrhage followed by massive blood transfusion may mask the diagnosis of PPCM or worsen the decompensated HF.
Case Description: We report a 35-year-old postpartum gemelli woman with a history of massive postpartum hemorrhage due to atonia uteri and Disseminated Intravascular Coagulation, complain of shortness of breath and fever. The patient received a massive blood transfusion for her massive postpartum hemorrhage. Physical examination revealed tachypnea and bilateral rales at lung bases. Chest radiographs showed cardiomegaly, right pleural effusion, and early lung edema. The echocardiography showed a decrease in left ventricular systolic function with ejection fraction of 41%, diastolic dysfunction, and global hypokinetic. She was diagnosed with PPCM, acute lung edema, pleural effusion, and pneumonia. Patient was treated with Furosemide continuous pump, Spironolactone, Bisoprolol, Valsartan. Her dyspnea greatly decrased with diuresis and antibiotic. She was discharged with HF medication continued.
Discussion: Women with PPCM typically present with symptoms of HF and signs of congestion. History of massive blood transfusion at first can mask the diagnosis of PPCM due to the possibility of Transfusion Associated Circulatory Overload, which also has signs of congestion. Massive blood transfusion can increase preload and may worsen the decompensated HF.
Conclusion: The presence of massive transfusion in a patient with PPCM can be challenging in diagnosing PPCM itself and the unpredictable course of decompensated HF in peripartum mothers. Due to its high mortality rate without proper treatment, prompt investigation is essential in improving maternal survival.