Implications of Liver Cirrhosis in Pregnancy

Abstract

Uterine leiomyosarcoma is an uncommon malignancy for which the management varies widely between individual gynaecologists and gynaecological oncology units. We have performed a retrospective review of patients treated at both the Royal Women's Hospital in Melbourne (1970-1997) and King George V Hospital in Sydney (1987-1993). In addition we have performed a survey of Certified Gynaecological Oncologists (CGO's) to assess the current management of uterine leiomyosarcomas in Australia. The results show varied management practices exist in Australia, many of which are not supported by evidence in the current literature. Oophorectomy in the premenopausal patient appears unnecessary unless the ovaries are macroscopically involved. The role of pelvic lymphadenectomy is debatable. This practice was recommended by many CGO's, yet these nodes are rarely positive unless obvious extrauterine disease is present. Adjuvant chemotherapy appears not to have a role at present unless in a trial setting. Adjuvant radiotherapy does appear to have a potential palliative role as it prevents locoregional relapse, although survival is not prolonged. Until suitable phase 3 trials are available, gynaecological oncology units should be meticulous in prospectively recording the clinical course of their patients and critically analyzing their current management strategies.

Malignant transformation of uterine leiomyoma

“…The age at presentation is an important factor although the study which was carried out in Australia in 1999 by Gard & colleagues showed that the incidence was approximately one leiomyosarcoma of the uterus in one million Australian women each year and the mean age of presentation was 55 years 5 . The uterine size for asymptomatic uteri greater than 12 weeks in size is not associated with an increased risk of malignant transformation to leiomyosarcoma, however, a very rapidly growing uterine tumour with large uteri there appears to be a risk for leiomyosarcoma 6 . This rapid growth of uterine myomas was arbitrarily defined as again at 6 weeks or more in gestational size within an interval of a year or less.…”

Pregnancy and Cirrhosis of the Liver

“…The major concern is variceal haemorrhage and endoscopic sclerotherapy prior to or during pregnancy may decrease this risk. Women with compensated cirrhosis can be expected to have a normal pregnancy and outcome without harm to either mother or fetus (10).…”

A Case Report on Decompensated Cirrhosis of Liver in Pregnancy

“…Pregnancy is uncommon in women with advanced cirrhosis and is associated with an increased risk of complications such as bleeding from esophageal varices, liver failure and hepato-renal syndrome [1][2][3][4] . Esophageal variceal bleeding has been reported in 18% to 32% of pregnant women with cirrhosis and in up to 50% of those with known portal hypertension 4,5 .…”

“…Investigations revealed hemoglobin of 11.2 gm/dl with total leukocyte count of 12000/mm 3 (85% polymorphs and 10% lymphocytes), platelets 1,40,000/mm 3 Abdominal and pelvic ultrasound (USG) revealed a shrunken liver, mild spleenomegaly, moderate ascities and 19 weeks viable twin pregnancy with breech presentation and marked ascites. She was positive for HBsAg by ELISA.…”