this kinda goes with the less then 55 EF thread

[ibvalerie]

I have been wondering about this a lot lately. I came on today and looked at the other folder and decided to take a peak, and found the other thread about pregnancy with a EF of less then 55. So I really started wondering about different things.

First off let me start by saying that we are done and not having anymore children but I was thinking about the what ifs.

Ok say I got pregnant with a EF that I have now with is 30-35. What would that mean to me other then a high risk pregnancy. Would it mean that death for me would be the only outcome? What would happen if someone got pregnant on all there meds. what would that mean for the baby? I have asked my DR and they keep saying what I went though last summer having Nathan and since would be a picnic compaired to what this kind of situation/ birth would be. But I guess I keep coming back to the "how" do we really know. Not a whole lot is known or gathered about PPCM, so maybe it is just something that happens in one pregnancy and doesnt really keep repeating its self? I have been told over and over again that if we do (meaning anyone with my lower EF and weak heart) That the only choice would be to terminate, do you think this is true? Not that I want to find out, but I was just wondering out load I guess.

It seems everytime I ask questions like this my DR starts having Heart Failure thinking about it....

Valerie
Madison 6-11-96
Gabriella 8-7-00
Nathan 6-17-04

DX on 6-14-04
EF at DX 10
Ef at 3m. 15
EF at 6m. 15
EF at 9m. and new bi-v pacer with ICD 20-25
EF on June 3 (almost one year) 30-35

[tabs]

Valerie, You are right in that there are no sure answers (there never really is in medicine). The big problem is the lower the ef the less "play" room there is for your heart to respond to the pregnancy. For me, I spent my pg with an ef of 40-43%. Within a week of delivery, at 36 weeks, my ef was 7%. While I was not on any heart meds at the time, I was on bed rest and high doses of prednisone. I do think that the prednisone may have saved my life! I think that the docs are worried that this same thing can and will happen to others with a low ef.

I, too, worry about an accidental pregnancy even with my tubal. I think that this worry is natural since we are on meds (ace inhibitors) that are contraindicated in pg. For me, I have come to the understanding that I will have to trust in God. If he decides that I should be pregnant, then I need to trust that he will take care of me!

I hope this helps, Twilah

[carrob]

Valerie,

I too think it's a "cushion" that the docs like to see. My docs feel that if I STAY at 40%....I'll do fine in a pregnancy. It's the drop that concerns them. And, even hubby is wanting to see some more improvement in my next echo.....July.....before we officially try. Like my High Risk OB said...it's a Las Vegas crap shoot,but you want to be at the best possible point you can be at before you try. I think my situation is different because I'm a little older (just turned 37 with NO children).....so we're a little more daring. For you younger girls.....I believe time is on your side. I've been told that I will stay on all the necessary meds and be watched very carefully throughout the pregnancy.

I wish I had the answers!!!!!!! :rolleyes:

[naturalmama1012]

From everything that I've been able to gather through research, reading, and asking questions, it seems that there are two "groups" as far as post-ppcm pgs. The only "comprehensive" study done on ppcm in subsequent pg was by Dr. Uri Elkayam out of CA, and it was with an extremely small group of women (40-ish?). In this study, there was a much lower rate of reoccurance and a zero death rate in the group of women who had fully recovered, and had normal EFs. In the group of women that had not recovered fully, and had EFs in the lower range, there was a higher rate of reoccurance and I believe a couple of deaths. There was also better recovery the 2nd time around by the "recovered" moms who lost function again vs. the "nonrecovered" who in some cases had lasting permanent damage the 2nd time around.

My EF by echo is 45-50%, by MUGA it always reads higher (last one was 59%). In a telephone consult with Dr. Elkayam he put me in the "lower risk" category of women that were fully recovered, because he said that in his study, the women he was looking at with problems, generally had an EF of 35% or below.

My own cardiologist has put me into the "higher risk" category because my EF is not 50% or above by echo, but I tend to go more with Dr. Elkayam's conclusion.

That said, I do know that I am on the borderline and if I lose any function at all, I am basically in heart failure...

However, at 39 weeks pg so far I've been just fine!

I think until a much larger study is done or a database is started to really track all the elements of all these post-PPCM pgs, we really won't know enough to conclusively determine risk... it's still a pretty grey area and we don't have enough pgs and outcomes to look at.

My personal feeling though is that the reoccurance rate is a lot lower than generally thought, especially in women who meet certain criteria (length of time to recover, EF at time of subsequent pg, etc.).