Peripartum Cardiomyopathy and Twin Pregnancy
Author: Emily Giannone
As far as my twin pregnancy was concerned, up until the boys’ birth, it was relatively uneventful (aside from the draining, constant nausea, and vomiting – yay genetics…thanks Mum).
During the third trimester, I began to experience significant shortness of breath, heart palpitations and panic attacks (not uncommon for any pregnancy). In the last week of pregnancy my feet and legs began to retain fluid. All these symptoms seemed harmless and ‘normal’ for a pregnant woman.
Twins born at 37 weeks. Welcome to the world!
The 27th of June 2019 (37+1 weeks pregnant), was the day we were booked in to meet our DCDA Fraternal twin boys. With all my anxiety, the best course of action was to be an elective c-section, so that as much as possible, I would be able to ‘cope’ and ensure that both boys were safe. In hindsight, electing to have that birth procedure quite possibly saved my life.
By 8:46am, Luca James and Rory David were delivered within the same minute and were whisked away for their testing. Both were showing signs of struggling to adjust to breathing and required further assistance.
It was at this point where I began to have intense chest pain; I thought my chest was going to explode. The anaesthetics team were onto it, and after a few minutes it subsided.
It’s not the machine, it’s her!
Fast forward to 10pm that night, when I remember yet another shrill ringing of the oxygen saturation alarm and two concerned midwives urging the on-call Anaesthetic Registrar to come assess me. He took arterial blood, conducted ECG’s on my heart, increased oxygen flow and x-rayed my chest. I was transferred to Critical Care Unit and placed on High-Flow Oxygen (which is awful). It’s a heavy-pronged nasal tube that pushes humid air up your nose and into your lungs like a jet, making breathing exceptionally difficult and uncomfortable.
Before I was moved, we detoured through the nursery so that I could meet my sons for the first time. They even organised for me to have skin-on-skin contact with them which became my most treasured memory.
The night CCU was a cycle of interrupted sleep for observations, setting off the oxygen machine, and not being able to fully relax into this nightmare.
I had to move hospitals and leave my babies behind
As I hadn’t improved, the following morning (oxygen saturation was 86 on 50% flow – the usual recovery is 6% flow), I was subject to further testing; a dye test for clots, antibiotics for pneumonia, chest x-rays and further ECGs. A diagnosis of Atelectasis (fluid on the lungs) was given, however the Intensive Care team were also alerted to assess me. The assessment showed that the left ventricle in my heart was working irregularly. Intensive care is at a completely different hospital, so I was to be moved by the MICA ambulance to their care, leaving my boys behind.
During my time in ICU, I was taken off fluids (as I was retaining too much in my lungs and legs), given high-pressure oxygen, hooked up to pain medication from the c-section, had further ECGs and had trouble maintaining a stable blood sugar reading. All the while missing my boys and seeing them only on videos and photos being sent to me or shown from visitors. It was not my idea of how their birth was going to go.
Once the testing showed I was stable and there was minimal fluid retention, I was moved back to the maternity hospital. I was then able to begin to heal from the c-section itself and meet my boys again (or what really felt like the first time). They felt strange to me at first – like they were someone else’s babies.
Peripartum Cardiomyopathy and twin pregnancy
My obstetrician had me referred to a Cardiologist for testing, as he believed there to be more to what had happened than just ‘fluid retention’.
Turns out, he was right! I have been given a diagnosis of Peripartum Cardiomyopathy, which is essentially pregnancy-related heart failure. With the stress on my body of the twin pregnancy, my heart had started to fail meaning, my lungs became compromised with fluid. In my case, I was lucky that my heart began to repair and return to normal on its own, without requiring medication, or having any ongoing issues. It is a difficult condition to detect as the symptoms mimic those of ‘normal’ third-trimester pregnancy and is likely to reoccur in further pregnancies.
Peripartum Cardiomyopathy and twin pregnancy is a very serious complication. I know I was lucky that it wasn’t worse. I got to come back to our babies and begin my journey of motherhood without further issues. Our boys are our pride and joy, and I do not regret anything about bringing into the world. They, and my husband, are my life.