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

Rasheed, Salah; Monem, Allam M. Abdel; Abdellah, Ahmed H.; Fattah, Mahmoud S. Abdel

doi:10.1016/j.ijgo.2012.12.020

Cited by 48 publications

(71 citation statements)

References 25 publications

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“…Pregnancy in women with underlying cirrhosis has been associated with an increase in prematurity, spontaneous abortions, and maternal-fetal mortality (164)(165)(166). Non-cirrhotic portal hypertension has been reported to have better outcomes than cirrhotics with portal hypertension ( 167 ).…”

Section: Primary Biliary Cirrhosismentioning

confidence: 99%

“…More recently, small series have reported safety with minimal to no adverse events for babies the second trimester, potentiated by an increase in intravascular volume, compression from the gravid uterus, and repeated Valsalva maneuvers ( 166 ). Up to 30% of cirrhotic pregnant women bleed from esophageal varices during pregnancy, and the risk of variceal bleeding increases up to 50-78% if there are pre-existing varices ( 163,167,168 ).…”

Section: Primary Biliary Cirrhosismentioning

confidence: 99%

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ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

234

257

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Consultation for liver disease in pregnant women is a common and oftentimes vexing clinical consultation for the gastroenterologist. The challenge lies in the need to consider the safety of both the expectant mother and the unborn fetus in the clinical management decisions. This practice guideline provides an evidence-based approach to common diagnostic and treatment challenges of liver disease in pregnant women. Am J Gastroenterol 2016; 111:176-194; doi: 10.1038/ajg.2015 Initial evaluation of pregnant patientA pregnant patient presenting with abnormal liver tests should undergo standard workup as with any non-pregnant individual (strong recommendation, very low level of evidence). Imaging in pregnancyUltrasound is safe and the preferred imaging modality used in assessment of abnormal liver tests suggestive of biliary tract disease (strong recommendation, low level of evidence).Magnetic resonance imaging without gadolinium can be used in the second and third trimester (conditional recommendation, low level of evidence).Computed tomography scans carry a risk of teratogenesis and childhood hematologic malignancies but may be used judiciously with minimized radiation protocols (2-5 rads; conditional recommendation, very low level of evidence). Endoscopy in pregnancyEndoscopy is safe in pregnancy but should be deferred until the second trimester if possible (strong recommendation, low level of evidence).Meperidine and propofol can be used for endoscopic sedation (strong recommendation, moderate level of evidence). Management of biliary disease in pregnancyERCP can be performed when indicated for pregnant women presenting with biliary disease that strongly necessitates intervention such as biliary pancreatitis, symptomatic choledocholithiasis, and/or cholangitis. Minimizing fetal exposure to fl uoroscopy is imperative (strong recommendation, low level of evidence).Symptomatic cholecystitis should be managed with early surgical intervention with laparoscopic cholecystectomy (strong recommendation, low level of evidence). Liver masses in pregnancyAsymptomatic hemangioma and focal nodular hyperplasia do not need routine imaging or surveillance during pregnancy (strong recommendation, very low level evidence).Hepatic adenomas should be monitored with ultrasound during pregnancy for growth. Patients with large adenomas (>5 cm) should be referred for resection prior to pregnancy (strong recommendation, low level of evidence). Hepatitis B in pregnancyActive-passive immunoprophylaxis with hepatitis B immunoglobulin and the HBV vaccination series should be administered to all infants born to HBV-infected mothers to prevent perinatal transmission (strong recommendation, low level of evidence).Women chronically infected with HBV and high viral load (>10 6 log copies/ml (200,000 IU/ml) and higher) should be offered antiviral medication with tenofovir or telbivudine in the third trimester to reduce perinatal transmission of HBV (strong recommendation, low level of evidence).C-section should not be performed electively in HBV-pos...

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Section: Primary Biliary Cirrhosismentioning

confidence: 99%

Section: Primary Biliary Cirrhosismentioning

confidence: 99%

ACG Clinical Guideline: Liver Disease and Pregnancy

Tran

Ahn

Reau

2016

American Journal of Gastroenterology

234

257

View full text Add to dashboard Cite

show abstract

“…Pregnancy in the cirrhotic patient carries a significant risk of complications and mortality to the mother, although the degree is difficult to determine. In retrospective studies and case series, the rate of complications and maternal mortality varies greatly from 10% to 80%, reflecting the heterogeneity of subjects . In a U.S. retrospective study conducted of 339 pregnant cirrhotic patients, Shaheen et al describe a maternal mortality rate of 1.8; in other series mortality was as high as 7.8%.…”

Section: Before Conceptionmentioning

confidence: 99%

“…Although pregnancy per se does not seem to exacerbate underlying liver disease or precipitate hepatic failure, some important exceptions include AIH and chronic hepatitis B, both of which will be discussed separately. These complications, along with postpartum hemorrhage and delivery complications, are responsible for the high maternal mortality rate that occurs in this group of patients …”

Section: Before Conceptionmentioning

confidence: 99%

“…These complications, along with postpartum hemorrhage and delivery complications, are responsible for the high maternal mortality rate that occurs in this group of patients. 7 Recently, the first prospective study addressing the natural history of posthepatitis cirrhosis in pregnancy was published. 7 The data confirmed poor maternal outcomes for pregnant patients with cirrhosis; in this study, the increased maternal morbidity in comparison to nonpregnant cirrhotic controls was secondary to variceal bleeding (78% vs. 19%).…”

Section: Maternal Outcomementioning

confidence: 99%

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