Peripartum Cardiomyopathy: The silent killer threatening new mothers

In a quiet corner of the female medical ward at Aminu Kano Teaching Hospital in Kano State, 40-year-old Amina Sani breathes with newfound ease, but her thin face still bears traces of exhaustion.

Her eyes tell a story of survival marked by pain, endurance, and a mother’s unyielding strength.

After weeks of struggling with breathlessness, swollen legs, and an enlarged abdomen, Amina was brought to AKTH by her 60-year-old stepmother, Mrs. Khadija Sani. By the time she arrived at the hospital, she was drenched in sweat and coughing up blood-streaked sputum. Now stable but fragile, Amina’s life may never return to what it once was.

“I used to wash clothes for people to earn a living, but with this condition, I can’t do anything strenuous anymore. The doctors also said I may not be able to have another child to avoid the illness coming back,” she said in Hausa.

A battle with no cure

Before arriving at the hospital, she had visited neighbourhood chemists and relied on local remedies, but nothing brought lasting relief to her symptoms.

“I couldn’t sleep or lie down well. It was a battle doing my daily chores. I would writhe in pain, and after taking some medications, I would feel okay for a while after those medications, but it always came back.

“I could not go to a good hospital because I work as a cleaner, so I could only seek cheaper and alternative treatments,” she recalled softly.

What started as a simple cough took a life-threatening turn a month after the birth of her first child at a Primary Health Care Centre in her Panshekara neighbourhood. Because of her condition, Amina was unable to breastfeed. Her weakness was so profound that her 10-year-old daughter became the primary caregiver to the newborn.

For her, this wasn’t the first time. She had developed similar symptoms years ago, but the illness returned with greater force after the birth of her last child.

“I don’t have diabetes and hypertension, and none of my family members have had those conditions. I thought it was just malaria or fatigue, but I still cannot explain what happened to me,” she said.

By the time she arrived at AKTH in early October, her heart was weak, enlarged, and failing.

Doctors diagnosed her with Peripartum Cardiomyopathy (PPCM).

According to a Consultant Cardiologist at AKTH, Dr. Ruqayya Sani, PPCM is a potentially life-threatening heart condition that can occur towards the end of pregnancy or after childbirth.

“The condition affects the muscle of the heart, and the muscular part does most of the pumping. They usually have breathlessness, especially after simple activities like walking or when they lie down. They also have fatigue and body swelling, which typically involves the legs, abdomen, and, in severe cases, even the face.

“Now, the challenge is, a lot of these things sound like what normal pregnant women will have when they are very heavy, which contributes to late recognition of the condition, as most patients are diagnosed after delivery. Some patients may also have cough, and sometimes this cough produces sputum, like catarrh, which sometimes this cough produces sputum, like catarrh, which sometimes is frothy, like it’s foaming, and sometimes there might even be some blood stains inside,” Dr. Sani said.

Motherhood’s cruel beginning

Amina’s diagnosis is the reality of a condition that has left many mothers like Nana Firdausi grappling with loss, illness, and fear for the future.

At just 20 years old, Firdausi should have been celebrating motherhood for the first time. Instead, she carries the weight of the loss of her baby, her health, and uncertainty about her future with her husband, and the hope of having another child.

Her journey began like any other expectant mother, but around her seventh month of pregnancy, things began to unravel.

“One evening, my chest felt like it was closing. At first, I thought it was pregnancy stress, but all of a sudden, my breathing became shallow, I vomited repeatedly, and I could not sleep,” she narrated.

Her mother, Mrs Hadiza Muhammad, and other relatives hurried her to a nearby clinic on a tricycle, where doctors measured her blood pressure and said it was due to pregnancy-induced hypertension.

They gave her medication and sent her home. But her symptoms became worse.

By the eighth month, her breathing came in gasps, her legs and face swollen.

Then her mother and other relatives rushed her to Murtala Mohammed Specialist Hospital, Kano, but she could not be admitted because of limited bed space. Then she went to another hospital before she was finally referred to AKTH.

“When we got to AKTH, 10 healthcare workers rushed to attend to her. They put her on oxygen because she could not breathe properly. They did a scan and found that her baby was lying down abnormally.

“They prepared her for an emergency Caesarean section. But before surgery could begin, she went into labour on her own, and she gave birth to a stillborn baby. She received a blood transfusion and medications,” her mother, Mrs Hadiza Muhammad, noted.

An echocardiogram later confirmed that she had PPCM. After nine days at the hospital, her breathing steadied.

Just like Amina, doctors warned her to be on contraceptives for now, and she may have to avoid further pregnancies to avoid recurrence of the condition.

“Even though the loss of her baby and the possibility of not having another child broke me, I am glad she is alive, and I am always with her to support her,” her mother, Hadiza Muhammad, added with her voice trembling.

Understanding the condition

Dr. Sani explained that no specific cause has been identified, though genetic factors and higher prevalence among women of African descent may contribute.

She stated, “We still haven’t found a specific cause of this condition, but there are several factors that contribute to it. One of the risk factors is likely genetic, because people who have a relative who has had the condition are more likely to have it. Although it occurs globally, women of African descent are the most affected.

“Other factors include increased maternal age, although in our environment, we see it more in younger women, and possibly nutritional deficiencies. There’s a micronutrient called selenium, which we think contributes to predisposing women when they’re pregnant or after delivery to this condition.

“In addition, if they have had hypertension in pregnancy, especially preeclampsia, they are more likely to come down with this condition. It appears a combination of these, and other factors which are yet to be discovered, makes some women’s heart muscles react abnormally to the pregnancy by becoming weak and unable to pump properly.

“The majority of patients who come to our facility with this condition come from low socio-economic backgrounds. That’s not to say only patients from low socio-economic backgrounds who suffer from this condition, sometimes we do have patients from a higher social class, including colleagues, and it’s present globally.”

She said even in advanced countries like the United States, PPCM appears to be significantly more common in women of African descent. Some research from the US shows that it is up to 16 times more common in Blacks.

“In Nigeria, we see it more frequently in the northwest region,” she stated.

According to her, the higher occurrence in the region may be linked to the high prevalence of preeclampsia, which is a pregnancy complication characterized by high blood pressure and swelling.

The cardiologist said that while some women may not show severe symptoms at first, PPCM often reveals itself through signs of heart failure.

“They begin to have difficulty in breathing, even when they walk a short distance or do light work, and it progressively worsens. Sometimes, just taking a bath becomes difficult. They get breathless easily, and lying flat makes breathing harder, so they can’t sleep well,” she said.

Other symptoms, she noted, include persistent cough and sputum that can appear foamy or even blood-stained, palpitations, and excessive fatigue and sometimes sweating.

“The challenge is that many of these symptoms look like what we see in normal pregnancy, although some patients only develop symptoms in the weeks after delivery. So it can be difficult for pregnant women and their caretakers to tell who has a real heart problem and who is just experiencing the usual discomforts of late pregnancy, which is why it is encouraged that pregnant women who have such persistent symptoms should go to thehospital to get evaluated,” she highlighted.

Statistics in Kano Hospital

Statistics obtained from the records in AKTH showed that over 100 to 120 women have been admitted with PPCM between January and October 2025, and an even larger number have been seen and treated as outpatients.

These figures come amid a troubling rate of deaths of pregnant women and new mothers in the country, which has one of the highest maternal mortality rates in the world.

Between January and September of this year, Nigeria recorded 3,689 maternal deaths, according to the latest health statistics report.

Troubling regional trend

A Nigerian study conducted across 22 hospitals in Nigeria between June 2017 and March 201