THE OUTCOME OF PERIPARTUM CARDIAC-FAILURE IN ZARIA, NIGERIA

We have studied 227 women who had peripartum cardiac failure (PPCF) in Zaria, Nigeria, since 1969-72. This follow-up and review of survivors in 1993-95 depended chiefly on a Zaria woman (A. Abdullahi) and on he r careful reporting. Overall, 31 (13.7%) were completely lost to follo w-up, 17 (7.5%) were thought to be alive, and there were data on 179 o thers (78.8%). Of the 75 known deaths, 55 were cardiovascular--20 due to PPCF, 31 due to cardiac failure unrelated to pregnancy (CF), and fo ur were due to a cerebrovascular accident. PPCF recurred in 13% of 551 subsequent pregnancies. Thirty-two women had a recurrence of PPCF onl y, and 27 an episode of CF only. Blood pressures rose steadily over th e years. An enlarged left ventricle on discharge after the index admis sion predicted a poor prognosis. In 1993-5, we compared 100 survivors with 100 non-PPCF controls: 96 PPCF women but only 50 control women to ok extra salt (p=0.0001). Significantly more PPCF women than controls had a diastolic pressure of 110mm Hg (p=0.011). The syndrome is probab ly provoked in potentially hypertensive women by the traditional pract ices of eating kanwa, which is rich in Na+, taking additional excess s alt and heating the body after delivery. Evidence is presented that PP CF women are potentially hypertensive, and cannot handle the excess in gested sodium which therefore leads to hypervolaemia and thus PPCF.