Outcomes of pregnancies complicated by liver cirrhosis, portal hypertension, or esophageal varices

Puljic, Anela; Salati, Jennifer; Doss, Amy; Caughey, Aaron B.

doi:10.3109/14767058.2015.1009438

Cited by 32 publications

(44 citation statements)

References 12 publications

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“…The prevalence of births in pregnancies in women with cirrhosis was much lower in our study (103 pregnancies in women with cirrhosis from 1.3 million pregnancies), which could be explained by the fact that the Palatnik and Rinella study included women from a single tertiary center representing a degree of ascertainment bias. Our findings are supported by a register‐based study from California that identified only 37 cases of cirrhosis in more than 2.2 million pregnancies, also without any report of maternal mortality . Therefore, it is reasonable to assume that improvements in both maternal and fetal care are contributing to decreased mortality in both instances in more recent publications.…”

Section: Discussionsupporting

confidence: 75%

“…Our findings are supported by a register-based study from California that identified only 37 cases of cirrhosis in more than 2.2 million pregnancies, also without any report of maternal mortality. (20) Therefore, it is reasonable to assume that improvements in both maternal and fetal care are contributing to decreased mortality in both instances in more recent publications. It is also noteworthy that in previous studies there was an increased risk for preeclampsia in women with cirrhosis, a finding not replicated in our cohort.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population‐Based Cohort Study of 1.3 Million Pregnancies

Hagström

Höijer

Marschall

et al. 2018

Hepatology Communications

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There are limited data on pregnancy outcomes in women with cirrhosis. To address this gap, we examined the records of singleton births from Sweden’s National Patient Register (NPR), Cause of Death Register (CDR), and Medical Birth Register (MBR) between 1997 and 2011 to assess exposure and pregnancy‐related and liver‐related outcomes of pregnant women with cirrhosis. Exposure status was defined as having an International Classification of Diseases (ICD) code for cirrhosis obtained prior to or during pregnancy. Poisson regression with cluster‐robust standard errors was used to estimate relative risks (RRs) adjusted for maternal age, smoking, and body mass index (BMI). We identified 103 pregnancies in women with cirrhosis and compared these to 1,361,566 pregnancies in women without cirrhosis. Pregnancies in women with cirrhosis were at increased risk of caesarean delivery (36% versus 16%, respectively; adjusted RR [aRR], 2.00; 95% confidence interval [CI], 1.47‐2.73), low birth weight (15% versus 3%; aRR, 3.87; 95% CI, 2.11‐7.06), and preterm delivery (19% versus 5%; aRR, 3.51; 95% CI, 2.16‐5.72). Rates of maternal mortality during pregnancy (no cases), gestational diabetes, preeclampsia, small for gestational age, congenital malformations, and stillbirth were not increased when compared to the pregnant women without cirrhosis. There were 12 hospitalizations during pregnancy due to liver‐related events, including one case with bleeding esophageal varices. Conclusion: Women with cirrhosis are at increased risk for adverse pregnancy outcomes. However, severe maternal and fetal adverse events were rare in our study, and most pregnancies in women with cirrhosis ended without complications.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population‐Based Cohort Study of 1.3 Million Pregnancies

Hagström

Höijer

Marschall

et al. 2018

Hepatology Communications

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“…Complications of portal hypertension are associated with significant increases in both mortality and complications during pregnancy or in the post-partum period. Increase in portal hypertension occurs during the last stages of the second trimester of pregnancy and is associated with increased risk of portal hypertension related bleeding in the later stages of pregnancy [229][230][231]. The available literature suggest considering TIPS placement in pregnant patients who bleed or rebleed despite an optimal pharmacological and endoscopic treatment.…”

Section: Haemophiliamentioning

confidence: 99%

Consensus conference on TIPS management: Techniques, indications, contraindications

Fagiuoli

Bruno

Venon

et al. 2017

Digestive and Liver Disease

130

120

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a b s t r a c tThe trans jugular intrahepatic Porto systemic shunt (TIPS) is no longer viewed as a salvage therapy or a bridge to liver transplantation and is currently indicated for a number of conditions related to portal hypertension with positive results in survival. Moreover, the availability of self-expandable polytetrafluoroethylene (PTFE)-covered endoprostheses has dramatically improved the long-term patency of TIPS. However, since the last updated International guidelines have been published (year 2009) new evidence have come, which have open the field to new indications and solved areas of uncertainty. On this basis, the Italian Association of the Study of the Liver (AISF), the Italian College of Interventional Radiology-Italian Society of Medical Radiology (ICIR-SIRM), and the Italian Society of Anesthesia, Analgesia and Intensive Care (SIAARTI) promoted a Consensus Conference on TIPS. Under the auspices of the three scientific societies, the consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Bergamo on June 4th and 5th, 2015. The final statements presented here were graded according to quality of evidence and strength of recommendations and were approved by an independent jury. By highlighting strengths and weaknesses of current indications to TIPS, the recommendations of AISF-ICIR-SIRM-SIAARTI may represent the starting point for further studies.

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“…Women undergoing liver biopsy during pregnancy are unlikely to be healthy, and effects on the fetus and pregnancy outcome may be due to both the liver biopsy procedure and the indication for biopsy. This is because liver disease, including AFLP, hepatitis C, autoimmune hepatitis, and liver cirrhosis, may have a negative impact on pregnancy outcome. We approached this potential bias in various ways.…”

Section: Discussionmentioning

confidence: 95%

Pregnancy outcome in women undergoing liver biopsy during pregnancy: A nationwide population‐based cohort study

et al. 2018

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Outcomes of pregnancies complicated by liver cirrhosis, portal hypertension, or esophageal varices

Cited by 32 publications

References 12 publications

Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population‐Based Cohort Study of 1.3 Million Pregnancies

Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population‐Based Cohort Study of 1.3 Million Pregnancies

Consensus conference on TIPS management: Techniques, indications, contraindications

Pregnancy outcome in women undergoing liver biopsy during pregnancy: A nationwide population‐based cohort study

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