Exacerbation of liver cirrhosis in pregnancy: a complex emerging clinical situation

Peitsidou, A.; Peitsidis, Panagiotis; Michopoulos, Spyridon; Matsouka, Charis; Kioses, E.

doi:10.1007/s00404-008-0811-4

Cited by 22 publications

(18 citation statements)

References 7 publications

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“…Women with chronic liver disease are often infertile secondary to a combination of metabolic, endocrine, nutritional, and sexual dysfunction. [19][20][21][22][23] Disruption of the hypothalamic-pituitary axis in conjunction with disturbed estrogen metabolism leads to anovulation, amenorrhea, and infertility. 21,22 LT often reverses infertility associated with chronic liver disease, and up to 80% of women will have a normal menstrual cycle and return of fertility within 8 months of LT. 21,[24][25][26] If these women are not educated about this change in fertility, then unwanted or unplanned pregnancies may occur.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of pregnancy following liver transplantation: The King's College Hospital experience

et al. 2015

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Reports of pregnancy in liver transplantation (LT) patients have largely favorable outcomes. Concerns remain with regards to maternal and graft risk, optimal immunosuppression (IS), and fetal outcomes. We review all post-LT pregnancies at our center with regard to the outcomes and safety for the patient, graft, and fetus. A total of 117 conceptions occurred in 79 patients. Median age at conception was 29 years. Maternal complications included graft loss (2%), acute cellular rejection (ACR; 15%), pre-eclampsia/eclampsia (15%), gestational diabetes (7%), and bacterial sepsis (5%). ACR was significantly more common in those women who conceived within 12 months of LT (P = 0.001). The live birth rate was 73%. Prematurity occurred in 26 (31%) neonates, and 24 (29%) neonates were of low or very low birth weight. IS choice (cyclosporine versus tacrolimus) had no significant effect on pregnancy outcomes and complications. No congenital abnormalities occurred, and only 1 child born at 24 weeks had delayed developmental milestones. In conclusion, pregnancy following LT has a favorable outcome in the majority, but severe maternal risks remain. Patients should be counseled with regard to the above information so informed decisions can be made, and pregnancy must be considered high risk with regular monitoring by transplant clinicians and specialist obstetricians.

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Section: Discussionmentioning

confidence: 99%

Outcomes of pregnancy following liver transplantation: The King's College Hospital experience

et al. 2015

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“…The most evident strength of the present study was its unique design. Unlike previous studies which were retrospective [1,6], case series [3,24], or case reports [25,26], the present study had a prospective longitudinal design. In addition, the present study included 2 control groups.…”

Section: Discussionmentioning

confidence: 99%

Prognosis and determinants of pregnancy outcome among patients with post‐hepatitis liver cirrhosis

Rasheed

Monem

Abdellah³

et al. 2013

Intl J Gynecology & Obste

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“…In the setting of cirrhotic portal hypertension, pregnancy is very rare due to hepatocellular damage leading to amenorrhea and infertility, the incidence of cirrhosis in pregnancy has been reported as 1 in 5950 pregnancies. 1 Cirrhosis may get exacerbated during pregnancy and has significant adverse effects on the mother and the baby. [2][3][4] In the developing countries, other causes like extrahepatic portal vein obstruction contribute significantly to noncirrhotic portal hypertension (NCPH).…”

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confidence: 99%

Pregnancy with Portal Hypertension

Aggarwal

Negi

Aggarwal

et al. 2014

Journal of Clinical and Experimental Hepatology

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Even though pregnancy is rare with cirrhosis and advanced liver disease, but it may co-exist in the setting of noncirrhotic portal hypertension as liver function is preserved but whenever encountered together is a complex clinical dilemma. Pregnancy in a patient with portal hypertension presents a special challenge to the obstetrician as so-called physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal hemorrhage. Risks of variceal bleed and hepatic decompensation increase many fold during pregnancy. Optimal management revolves round managing the portal hypertension and its complications. Thus management of such cases requires multi-speciality approach involving obstetricians experienced in dealing with high risk cases, hepatologists, anesthetists and neonatologists. With advancement in medical field, pregnancy is not contra-indicated in these women, as was previously believed. This article focuses on the different aspects of pregnancy with portal hypertension with special emphasis on specific cause wise treatment options to decrease the variceal bleed and hepatic decompensation. Based on extensive review of literature, management from pre-conceptional period to postpartum is outlined in order to have optimal maternal and perinatal outcomes. ( J CLIN EXP HEPATOL 2014;4:163-171) P regnancy associated with liver diseases is an infrequent situation, but when seen together, presents a complicated clinical situation. Portal hypertension develops as a result of number of etiologies. In the west, cirrhosis is the commonest cause of portal hypertension. In the setting of cirrhotic portal hypertension, pregnancy is very rare due to hepatocellular damage leading to amenorrhea and infertility, the incidence of cirrhosis in pregnancy has been reported as 1 in 5950 pregnancies. 1 Cirrhosis may get exacerbated during pregnancy and has significant adverse effects on the mother and the baby. [2][3][4] In the developing countries, other causes like extrahepatic portal vein obstruction contribute significantly to noncirrhotic portal hypertension (NCPH). Mostly liver function is much better preserved in women with NCPH and pregnancy is spontaneous in these women. Portal hypertension associated with pregnancy is a high risk situation as both pregnancy and portal hypertension share some of the hemodynamic changes. The physiological changes, in adaptation to the pregnancy and fetal needs, worsen the portal hypertension resulting in potentially life-threatening variceal bleed and other complications. Pregnancy is a potential hazard for occurrence of recurrent variceal bleed due to its hyperdynamic state causing increase in flow to the collaterals. 5-7 Therefore management in pregnancy requires knowledge of both the effects of changes during pregnancy on portal hemodynamics and the effects of portal hypertension and its cause on both mother and fetus, hepatotoxic...

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Exacerbation of liver cirrhosis in pregnancy: a complex emerging clinical situation

Cited by 22 publications

References 7 publications

Outcomes of pregnancy following liver transplantation: The King's College Hospital experience

Outcomes of pregnancy following liver transplantation: The King's College Hospital experience

Prognosis and determinants of pregnancy outcome among patients with post‐hepatitis liver cirrhosis

Pregnancy with Portal Hypertension

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