Publication:

Pregnancy with chemotherapy induced cardiomyopathy (EF 30%): a tertiary care success story

Chemotherapy-induced cardiomyopathy in pregnancy represents a rare but high-risk clinical scenario, particularly when left ventricular ejection fraction falls below 30%. Limited literature exists on the peripartum management of such cases. A 23-year-old primigravida with a history of osteogenic sarcoma treated with chemotherapy presented at 36 weeks of gestation with chemotherapy-induced dilated cardiomyopathy and ejection fraction of 30%. The patient was hemodynamically stable on admission with vital signs of heart rate 100 bpm and blood pressure 120/80 mm Hg. Echocardiography revealed global left ventricular hypokinesia, trivial mitral regurgitation and dilated left atrium. Obstetric ultrasound showed normal foetal growth with normal doppler studies. A multidisciplinary approach was implemented involving obstetrics, cardiology, anaesthesiology and neonatology teams. Elective lower segment caesarean section was performed under combined spinal-epidural anaesthesia using 0.2% lignocaine with fentanyl. Comprehensive perioperative monitoring included central venous access, ICU preparedness, and availability of inotropic support. The procedure resulted in successful delivery of a healthy female neonate with estimated blood loss of 700 ml. The patient remained hemodynamically stable throughout the perioperative period and was discharged on postoperative day 8 without complications. This case demonstrates that pregnancy complicated by severe chemotherapy-induced cardiomyopathy can be successfully managed through coordinated multidisciplinary care, appropriate timing of delivery and regional anaesthesia techniques in a tertiary care setting. The favourable outcome achieved despite the patient's critically low ejection fraction emphasizes the importance of specialized cardio-obstetric expertise and comprehensive peripartum planning.