Pregnancy in a patient with portal hypertension secondary to liver cirrhosis

Lelei-Mailu, Faith; Mariara, Charles

doi:10.1136/bcr-2017-223076

Cited by 4 publications

(5 citation statements)

References 11 publications

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“…However, no difference in missed abortion and spontaneous abortion were found between pregnant patients with cirrhosis or not in a previous larger population study [5] and in our study. The maternal death rates had decreased from 10 to 1%~1.8% as the medical therapy developing [3,11,12]. In the previous study, most maternal mortality was attributed to hemorrhage from gastrointestinal varices, occurring most commonly in the second trimester and during labor [9,13].…”

Section: Discussionmentioning

confidence: 93%

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Maternal and fetal outcomes of patients with liver cirrhosis: a case-control study

Gao

Zhu

Liu

et al. 2021

BMC Pregnancy Childbirth

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Background We aimed to describe the characteristics and outcomes in pregnant women with liver cirrhosis, and identify the predictors of adverse events of mother and fetus. Methods Retrospectively collected mothers with liver cirrhosis in our center from 6/2010 to 6/2019. Women without liver cirrhosis were selected as a control in a 1:2 ratio. The primary assessment was the frequency of maternal and fetal adverse events. The secondary assessment was the adverse events in patients continuing pregnancy or not and the factors to predict the severe adverse events. Results Of 126 pregnancies enrolled, 29 pregnancies were terminated for worrying disease progression and 97 pregnancies continued. One hundred ninety-four pregnancies without liver cirrhosis were selected as control. At baseline, patients with liver cirrhosis have a lower level of platelet, hemoglobin, prothrombin activity, and a higher level of ALT, total Bilirubin, creatinine. Compared to control, patients with liver cirrhosis had a higher frequency of adverse events, including bleeding gums (7.2%vs. 1.0%), TBA elevation (18.6%vs.3.1%), infection (10.3%vs.0.5%), cesarean section (73.6%vs.49.5%), postpartum hemorrhage (13.8% vs 2.1%), blood transfusion (28.9% vs 2.1%), new ascites or aggravating ascites (6.2% vs.0%), MODS (7.2% vs.0.5%) and intensive care unit admissions (24.1% vs 1.1%). The incidence of severe maternal adverse events was also higher (32.0% vs 1.5%). Women who chose to terminated the pregnancy had less severe adverse events (3.4% vs.32.0%). A higher frequency of fetal/infants’ complications was observed in liver cirrhosis population than control, including newborn asphyxia (10.2% vs1.1%), low birth weight infant (13.6% vs. 2.6%). In patients who progressed into the third trimester, multivariable regression analysis demonstrated that severe adverse events were associated with a higher CTP score (OR 2.128, 95% CI [1.002, 4.521], p = 0.049). Wilson’s disease related liver cirrhosis has a better prognosis (OR = 0.009, 95% CI [0, 0.763], p = 0.038). Conclusions The incidence of the adverse events was significantly increased in pregnancies complicated by cirrhosis. The predictor of severe adverse events is higher CTP score. Wilson’s disease induced liver cirrhosis have a better prognosis. Timely termination of pregnancy during the first trimester may avoid the incidence of severe adverse events.

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Section: Discussionmentioning

confidence: 93%

“…The maternal death rates had decreased from 10 to 1% ~ 1.8% as the medical therapy developing [ 3 , 11 , 12 ]. In the previous study, most maternal mortality was attributed to hemorrhage from gastrointestinal varices, occurring most commonly in the second trimester and during labor [ 9 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Maternal and fetal outcomes of patients with liver cirrhosis: a case-control study

Gao

Zhu

Liu

et al. 2021

BMC Pregnancy Childbirth

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“…Several successful cases with the use of transjugular intrahepatic portosystemic shunt (TIPS) have been reported [211]. Worsening of ascites with compromised respiratory function has also been reported in these patients [212].…”

Section: Portal Hypertension In Chronic Hbv-infected Females With Est...mentioning

confidence: 99%

Asian Pacific association for the study of liver (APASL) guidelines: hepatitis B virus in pregnancy

et al. 2022

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Hepatitis B virus (HBV) infection still remains a major public health issue in the Asia-Pacific region. Most of the burden of HBV-related disease results from infections acquired in infancy through perinatal or early childhood exposure to HBV in Asia-Pacific. Hepatitis B during pregnancy presents unique management issues for both the mother and fetus. These APASL guidelines provide a comprehensive review and recommendations based on available evidence in the literature, for the management of females with HBV infection through every stage of pregnancy and postpartum. These also address the concerns, management challenges, and required follow-up of children born to hepatitis B-positive mothers.

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“…With the development of therapeutic options for liver cirrhosis, maternal death rates have decreased from 10% to 1-1.8% [49,119]. One of the main complications of liver cirrhosis is variceal hemorrhage.…”

Section: Cirrhosismentioning

confidence: 99%

State of the Art in Hepatic Dysfunction in Pregnancy

et al. 2021

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Hepatic dysfunction in pregnant women is always challenging for the obstetrician, as the spectrum of hepatic abnormalities can be very large and have various implications, both for mother and fetus. There is a diagnostic and therapeutic polymorphism of hepatic dysfunction in pregnancy and insufficient knowledge related to the etiopathogenesis and epidemiology of this disease. The clinical forms of hepatic dysfunction encountered in pregnancy can vary from liver diseases related to pregnancy (e.g., HELLP syndrome, intrahepatic cholestasis, hyperemesis gravidarum, or acute fatty liver of pregnancy) to de novo ones occurring in pregnancy, and pre-existing liver disease (cholelithiasis, Budd–Chiari syndrome, and cirrhosis). We performed a systematic literature search over 10 years. The review protocol assumed a search of two databases (PubMed®/MEDLINE and Web of Science Core Collection). The strategy regarding the management of these diseases involves multidisciplinary teams composed of different specialists (obstetricians, gastroenterologists and anesthetists) from specialized tertiary centers. Despite the improving prognosis of pregnant women with liver diseases, the risk of maternal–fetal complications remains very high. Therefore, it is necessary to ensure careful monitoring by a multidisciplinary team and to inform the patients of the potential risks.

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Pregnancy in a patient with portal hypertension secondary to liver cirrhosis

Cited by 4 publications

References 11 publications

Maternal and fetal outcomes of patients with liver cirrhosis: a case-control study

Maternal and fetal outcomes of patients with liver cirrhosis: a case-control study

Asian Pacific association for the study of liver (APASL) guidelines: hepatitis B virus in pregnancy

State of the Art in Hepatic Dysfunction in Pregnancy

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