A case of peripartum cardiomyopathy: postpartum decompensati
The present case has been reported in the International Journal of Obstetric Anaesthesia. The utility of a non-invasive cardiac output monitor (NICOM™) in guiding the peripartum management and identification of postpartum complications in a patient with severe peripartum cardiomyopathy is reported.

A 31-year-old nulliparous woman at 35 weeks of gestation presented with a three-week history of worsening dyspnea and progressive functional deterioration. A transthoracic echocardiogram showed severe left ventricular systolic dysfunction with an ejection fraction <20%. Cardiac status was monitored using NICOM™ during labor and delivery.

The baseline values were: cardiac output 5.3 L/min, total peripheral resistance 1549 dynes.sec/cm5, stroke volume 42.1 mL and stroke volume variation 18%. She received early epidural analgesia during labor, titrated slowly with a loading dose of 0.0625% bupivacaine 10 mL and fentanyl 25 μg, followed by patient-controlled epidural analgesia (0.0625% bupivacaine with fentanyl 2 μg/mL, infusion at 10 mL/h, bolus dose 5 mL and lockout interval 10 min).

After epidural drug administration, total peripheral resistance decreased, cardiac output increased, and satisfactory analgesia was obtained. She had an uneventful vaginal delivery with a forceps-assisted second stage after prophylactic administration of furosemide 20 mg. NICOM™ was discontinued after delivery.

Fifteen hours post-delivery, the patient developed cardiogenic shock, which resolved after aggressive therapy with inotropes and furosemide. NICOM™ can be used to guide treatment during labor and delivery in patients with critical peripartum cardiomyopathy.

The authors suggest that use of NICOM™ be extended into the postpartum period to detect signs of cardiac decompensation in such patients.

Read in detail here: https://www.obstetanesthesia.com/article/S0959-289X(13)00153-2/fulltext
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