Heart complications after childbirth

Larra woke up with a start, sitting up suddenly. She reached out and shook Todd firmly, waking him up as well. She thought she was having a nightmare but could not remember what it was about. All she knew was that she could not breathe, like someone was strangling her.

Todd groggily sat up, asking what was wrong with the baby. Their three-week-old daughter was peacefully snoring in her co-sleeper next to him. He turned to Larra, concern written all over his face. Larra did not look too good.

Larra had enjoyed her pregnancy, with minimal discomforts. She ate well, gained weight appropriately and enjoyed the deep connection with her unborn baby. When it was time for the baby to come, Larra handled labour like a champ.

The contractions lasted five hours before baby Anisa arrived, all loud and pink, yelling lustily in the delivery suite. Todd wiped away tears as he cut his baby’s umbilical cord. 

The next evening, the couple took Anisa home, to a warm welcome by her extended family. The post-delivery period started off smoothly. Larra and Anisa both figured out the breastfeeding business quite fast. Anisa fed, let her bowels loose and slept. She was rarely fussy, even when awake. Todd proved to be invaluable. He gave Anisa her first bath at home while Larra looked on.

However, over the past week, Larra looked tired and worn out even when she had not done much during the day. Todd kept asking her to nap during the day when Anisa slept, but it did not seem to help. At Larra’s review on the 10th post-natal day, she had been perfectly fine, with mild oedema on her feet, and it was fading.

However, Larra seemed to be taking a turn for the worse. At night she would add an extra pillow in order to find a comfortable position to sleep in. Todd also noted that the oedema was back and worsening. The previous evening, she had needed his support to get back upstairs after dinner. He wanted to call and schedule another review but Larra told him to hold on.

Heart beating wildly
Now here she sat, her heart beating wildly, her breathing fast and shallow and her face looking drained. She was clutching onto her chest because of the discomfort. Todd did not hesitate. He got dressed in a flash, woke up the nanny and handed Anisa over before calling his mum to come and help. His call came through about 1.00am, and we agreed to meet at the emergency department. 
He wrapped Larra in a warm dressing gown and carried her to the car. He tucked a blanket around her and sped off to the hospital.

At the emergency department, the team receiving Larra had already put her on oxygen support and ordered a battery of tests to ascertain what was ailing her. Her bed remained propped up to keep her comfortable. The vein on her neck was bulging with every breath. Preliminary examination pointed to possible heart failure and we immediately got the cardiologist on board.

In the wee hours of the morning, Larra was wheeled to the high-dependency unit (HDU) with Todd whispering a prayer, holding tightly onto her hand. The cardiologist eventually put a name to what was ailing Larra: peripartum cardiomyopathy. The first three days were stormy, but Larra hung on to dear life. She had no intention of leaving Anisa without a mother.

Cause
Peripartum cardiomyopathy is heart failure occurring in a woman in the period between the last month of pregnancy and up to five months post-partum. Further, all other causes of heart failure need to have been excluded. 

The cause of peripartum cardiomyopathy remains unknown, though theories abound, such as viral infections, hormonal injury to the heart lining and muscles, and inability to handle the pregnancy burden.

However, despite the obscure cause, the risk of developing the condition has been linked to older mothers above the age of 30 years, those who have been pregnant multiple times, those with a multiple pregnancy such as twins or triplets, African women, poverty, cocaine use and tobacco smoking.

On the mend
By the end of the week, it was clear that Larra was on the mend. She was moved from the High Dependency Unit to the wards and thereafter, she was able to go back home. 

Long-standing intensive follow-up with her cardiologist saw Larra’s heart slowly regain full function and allow her to get off medication. It was not an easy journey.

The couple is grateful for the opportunity to raise baby Anisa together. The price to pay for giving her a sibling is way too high to even consider at the moment. Larra was one of the very lucky ones. 

Prevalence
It is worth noting that in some parts of the world, up to 50 percent of mothers who get peripartum cardiomyopathy do not make it. Another 20 to 30 percent will survive it but will remain on lifelong treatment for chronic heart failure.

Considering this is a condition that happens in one in 1,000 to 3,000 births, it poses a remarkable health burden.