Pregnancy in liver cirrhosis and/or portal hypertension

Negi

Journal of Clinical and Experimental Hepatology

et al. 2014

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...

mentioning

confidence: 99%

Pregnancy with Portal Hypertension

Negi

Journal of Clinical and Experimental Hepatology

et al. 2014

“…Byrd et al reported 50 pregnancies in 27 cirrhotic and non-cirrhotic patients; bleeding VO occurred in 34% of cases (20) . Cheng relates bleeding by rupture of VO in 44% of cases of 32 cirrhotic and noncirrhotic pregnancies (21) . The original version of rupture risk is variable depending on the etiology of PHT, it is higher in the case of extra PHT liver, occurring in over 43% of cases, while it is 23% in patients with cirrhosis (22) .…”

Section: Discussionmentioning

confidence: 99%

Portal Hypertension and Pregnancy: Three Cases

Belaazri¹,

Lamine²,

siati³

et al. 2017

IAM

The occurrence of pregnancy in a woman with an HTP is daunting because of the possibility of maternal and fetal worsening. The character of a high-risk pregnancy is confirmed by the frequency of gastrointestinal bleeding, spontaneous abortions and premature deliveries. Clinical symptomatology is often dominated by the complications, and the ultrasound and endoscopy, can confirm the diagnosis and detecting complications. The management of pregnancies among women with HTP must begin before conception to postpartum. It requires close collaboration between obstetricians, gastroenterologists, anesthetists and neonatologists. Our study concerns three cases of portal hypertension in pregnancy collected in the service of gynecology & obstetrics, and intensive care unit in the University Hospital Ibn Sina of Rabat. In light of these three observations, we discuss mainly, the physiopathological particularity, evolutionary aspects, and principles in the management of these pregnancies at risk.

“…However, cirrhosis is not a contraindication, as pregnancy may be tolerated if cirrhosis is well-compensated and without features of portal hypertension [99] . Portal hypertension leads to increased maternal complications, including variceal hemor rhag e, he patic failure, encephalopathy, jaundice, malnutrition, and splenic artery aneurysm [100] . Bleeding from esophageal varices has been reported in 20%-25% of pregnant women with cirrhosis [101] .…”

Section: Cirrhosismentioning

confidence: 99%

Liver Disease in Pregnancy

Lee¹,

Koh²

1988

Yeungnam Univ J Med

Liver diseases in pregnancy may be categorized into liver disorders that occur only in the setting of pregnancy and liver diseases that occur coincidentally with pregnancy. Hyperemesis gravidarum, preeclampsia/eclampsia, syndrome of hemolysis, elevated liver tests and low platelets (HELLP), acute fatty liver of pregnancy, and intrahepatic cholestasis of pregnancy are pregnancy-specific disorders that may cause elevations in liver tests and hepatic dysfunction. Chronic liver diseases, including cholestatic liver disease, autoimmune hepatitis, Wilson disease, and viral hepatitis may also be seen in pregnancy. Management of liver disease in pregnancy requires collaboration between obstetricians and gastroenterologists/hepatologists. Treatment of pregnancy-specific liver disorders usually involves delivery of the fetus and supportive care, whereas management of chronic liver disease in pregnancy is directed toward optimizing control of the liver disorder. Cirrhosis in the setting of pregnancy is less commonly observed but offers unique challenges for patients and practitioners. This article reviews the epidemiology, pathophysiology, diagnosis, and management of liver diseases seen in pregnancy.