Liver cirrhosis and pregnancy: a case report and review of literature

Abstract

Liver cirrhosis is a chronic liver disease in which the liver tissue and the vascular beds are remodeled leading to impaired hepatic function. Portal hypertension and subsequent esophageal varices are a frequent complication of liver cirrhosis and are a cause of mortality in patients with liver cirrhosis. Pregnancy in women with liver cirrhosis is uncommon, the incidence being about 1 in 5 950 pregnancies. Hepatocellular damage and the associated alteration in the metabolism of the sex hormones is thought to be responsible and leads to anovulation. In spite of all these factors, women with cirrhosis can and do become pregnant. Pregnancy is successful in most of the patients with chronic liver disease, but maternal and fetal complication rates are still high for decompensated liver cirrhosis. Portal hypertension associated with pregnancy is a high-risk situation as both pregnancy and portal hypertension share some of the hemodynamic changes. Risks of variceal bleeding and hepatic decompensation increases many fold during pregnancy. Despite the possible complications mentioned above, the maternal-fetal morbidity and mortality rates have been decreased by the current developments in hepatology, prevention of bleeding from varices with drugs and/or endoscopic variceal ligation, improvement in liver transplantation, and an increased experience in these issues. We present a case of a 31-year-old female patient with liver cirrhosis who successfully managed pregnancy and birth without complications after the insertion of transjugular intrahepatic portosystemic shunt (TIPS). Unfortunately, 2 years after delivery, the patient developed lymphoblastic lymphoma and, despite intensive therapy for this disease, the patient died at the age of 40. We did not find any link between liver cirrhosis and lymphoblastic lymphoma.

Case report: Successful pregnancy complicated with non-cirrhotic portal hypertension in a lady who suffered from postpartum hemorrhage previously

“…[1] This is because reports on pregnancy with NCPH are sparse and heterogeneous. [4][5][6][7] Pregnancy complications are more frequent and severe in cirrhotic PH than in non-cirrhotic PH because the severity of the liver disease is closely correlated with poor maternal and neonatal outcomes in PH. [7] Unfavorable pregnancy outcomes are linked to the catastrophic PH complication of GI hemorrhage.…”

“…[4][5][6][7] Pregnancy complications are more frequent and severe in cirrhotic PH than in non-cirrhotic PH because the severity of the liver disease is closely correlated with poor maternal and neonatal outcomes in PH. [7] Unfavorable pregnancy outcomes are linked to the catastrophic PH complication of GI hemorrhage. According to reports, 78% of pregnant women who had esophageal varices diagnosed with PH before becoming pregnant will experience bleeding.…”

“…[ 4 – 7 ] Pregnancy complications are more frequent and severe in cirrhotic PH than in non-cirrhotic PH because the severity of the liver disease is closely correlated with poor maternal and neonatal outcomes in PH. [ 7 ]…”