Delivery and PPCM:
Unless there is deterioration in the maternal or fetal condition, there is no need for early delivery.
Urgent delivery, irrespective of gestation, may need to be considered in women presenting or remaining in advanced HF with haemodynamic instability.
In general, spontaneous vaginal birth is preferable in stable women.
Caesarean section is preferred for patients who are critically ill and in need of inotropic therapy or mechanical support.
Prognosis of PPCM:
The prognosis is better than with other causes of dilated cardiomyopathy, with normalization of LV function in >50% of patients, mostly occurring within 2 to 6 months after diagnosis.
Up to 13% of patients may have major events or persistent severe cardiomyopathy.
Factors associated with lack of recovery at initial assessment are LVEDD >5.6 cm, the presence of LV thrombus, and African-American race.
Pregnancy is discouraged in women with LVEF <25% at diagnosis that has not been normalized at 2 months. However, even if the LVEF is normalized, there is still a need for counselling because of the risk of recurrence with a new pregnancy.