100 QUESTIONS IN CARDIOLOGY

91 How do I manage the pregnant woman with

dilated cardiomyopathy?

Sara Thorne

The management of a pregnant woman with dilated cardio-

myopathy should be considered in terms of maternal risk, and

risk to the fetus.

Maternal risk

This relates to the degree of ventricular dysfunction and the

ability to adapt to altered haemodynamics. Risk and management

can therefore be discussed in relation to New York Heart

Association (NYHA) functional class:

NYHA I-II

• Should manage pregnancy without difficulty (maternal

mortality 0.4%)

• May require admission for rest and diuretic therapy


• Venous thrombosis prophylaxis with heparin for patients on

bedrest

NYHA III

• At significant risk (maternal mortality for NYHA III-IV 6.8%)


• Planned hospital admission for rest, treatment of heart failure

and monitoring

• Risk of deterioration in ventricular function which may not

improve post-partum.

• Early delivery if heart failure progressive despite optimal in-

patient management

NYHA IV

• Should be advised not to become pregnant. Therapeutic

abortion should be considered.