Contemporary Management of Cardiogenic Shock During Pregnancy

Abstract

Cardiogenic shock is the most extreme cardiovascular disease state in pregnancy. Peripartum cardiomyopathy is the most common etiology of cardiogenic shock towards the end of pregnancy and in the early postpartum period. Therapy for cardiogenic shock relies on appropriate phenotyping of shock etiology, severity, and ventricular predominance, which are critical in appropriate selection of medical and mechanical therapy. Mechanical circulatory support may be used as a bridge to recovery or as definitive therapy. Intra-aortic balloon pump, percutaneous left ventricular assist devices, and veno-arterial extracorporeal circulatory devices have been successfully used in pregnancy and the post-partum period. The most utilized mechanical therapy in the pregnant patient is extracorporeal membranous oxygenation circulatory support. The use of mechanical circulatory devices in peripartum cardiomyopathy has contributed to improved survival in recent years. Further efforts to identify the optimal mechanical circulatory support strategy for peripartum cardiomyopathy and cardiogenic shock in the peri-partum period are needed.