The association between pregnancy and cardiomyopathy has been described since 1849 (Richie, 1849). The reported incidence of peripartum cardiomyopathy (PPCM) varies, with a recent review suggested an incidence of one in 3,000 to 4,000 pregnancies in western countries (Curry et.al, 2009). Increased awareness of PPCM may lead to early diagnosis and appropriate treatment that will reduce the risks of maternal and fetal morbidity.
Diabetes insipidus is a rare complication in pregnancy and its incidence can be up to 1 in 30,000 pregnancies (Ananthakrishnan, 2009). The decreased central secretory reserve or impaired renal responsiveness to vasopressin in women with central or nephrogenic diabetes insipidus can lead to symptoms of polyuria and polydipsia. It is important to differentiate central diabetes insipidus, which can be managed with 1-deamino-8-D-arginine vasopressin (desmopressin acetate) (DDAVP), and nephrogenic diabetes insipidus which is typically resistant to both DDAVP and vasopressin.
We describe the management of PPCM in a morbidly obese woman with diabetes insipidus that predated the pregnancy. It involved the contribution of multidisciplinary team including the obstetricians, anaesthetists, cardiologists, endocrinologist, neonatologists as well as the intensive care team. The challenge in management in this case included fluid balance, patient’s non-compliance, prematurity of fetus and the technical difficulty in caring for a morbidly obese woman. Her postnatal course was complicated by multi-organ failure and cerebral vascular accident secondary to embolization from thrombus in the left ventricle of the heart.