Abstract

Peripartum cardiomyopathy (PPCM) is a rare form of dilated cardiomyopathy presenting as new-onset heart failure in late pregnancy or early postpartum. It is characterized by reduced left ventricular ejection fraction (≤45%) and carries significant maternal and fetal risk. Anaesthetic management is challenging due to susceptibility to arrhythmias, pulmonary edema, and hemodynamic instability, with limited evidence to guide optimal techniques.

This report describes two parturients with severe PPCM (ejection fraction 20–27%) requiring caesarean delivery. Both underwent a combined general anaesthesia and epidural approach after multidisciplinary evaluation. Induction with etomidate or propofol and succinylcholine resulted in hypotension requiring norepinephrine support. Maintenance was achieved with oxygen–nitrous oxide, and opioids were administered after delivery. Uterotonics were avoided to prevent abrupt cardiovascular changes. Neonatal outcomes were good, and maternal recovery was uneventful.

These cases demonstrate that a carefully titrated combined anaesthetic technique with meticulous hemodynamic management can facilitate safe delivery in severe PPCM.

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