Pregnancy and Vascular Liver Disease

Abstract

Vascular disorders of the liver frequently affect women of childbearing age. Pregnancy and the postpartum are prothrombotic states. Pregnancy seems to be a trigger for Budd-Chiari syndrome in patients with an underlying prothrombotic disorder. Whether pregnancy is a risk factor for other vascular liver disorders is unknown. In women with a known vascular liver disorder and a desire for pregnancy, stabilisation of the liver disease, including the use of a portal decompressive procedure when indicated, should be reached prior to conception. The presence of esophageal varices should be screened and adequate prophylaxis of bleeding applied in a manner similar to what is recommended for patients with cirrhosis. Most women likely benefit from anticoagulation during pregnancy and the postpartum. Labor and delivery are best managed by a multidisciplinary team with experience in this situation. Assisted vaginal delivery is the preferred mode of delivery. Although the risk of miscarriage and premature birth is heightened, current management of these diseases makes it very likely to see the birth of a live baby when pregnancy reaches 20 weeks of gestation.

Pregnancy and liver disease

“…Budd-Chiari syndrome (BCS) can present de novo in pregnancy or pregnancy can result in thrombus extension with an acute on chronic presentation [168][169][170][171]. There is often the presence of an additional pro-coagulant factor and hence a full pro-coagulant search is imperative even in the context of pregnancy [170,172]. Historically, reports of BCS presenting in pregnancy were associated with poor outcomes for the fetus and mother with death from hepatic failure or portal hypertension being common [169,[173][174][175][176].…”

“…Historically, reports of BCS presenting in pregnancy were associated with poor outcomes for the fetus and mother with death from hepatic failure or portal hypertension being common [169,[173][174][175][176]. The treatment for BCS has evolved over several decades and 5-year survival rates have improved from 50% to 90%, which is mirrored in the survival of pregnant women with BCS [171,172]. Young women with BCS may express a desire for pregnancy once their underlying condition has improved.…”

Successful Pregnancy Outcome with Extra Hepatic Portal Venous Obstruction: Three Case Series

“…The etiological factors associated include home delivery and umbilical sepsis [2]. EHPVO in pregnancy is rare, and very few studies pertaining to it have been reported [3]. The mean maternal age in our study was 30 years, whereas the mean age in a large case series was 24 years.…”

“…An overall favorable outcome has been reported in all case studies, and no maternal deaths have been reported [3][4][5][6].…”

Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis

“…207,208 Outcomes of pregnancy in women with vascular diseases of the liver and the management of pregnancy and delivery has been reviewed elsewhere in detail. 209 Briefly, the presence of oesophageal varices should be screened and adequate prophylaxis of bleeding applied in a manner similar to what is recommended for patients with cirrhosis. Portopulmonary hypertension should be searched for prior to conception, since pregnancy can worsen lung disease.…”