Portal hypertension in pregnancy – Concealed perils

Abstract

Pregnancy in women with portal hypertension is high risk due to the danger of variceal haemorrhage, which complicates 15–34% of cases. Variceal bleeding in pregnancy to women with non-cirrhotic portal hypertension is associated with increased risk of abortion (29%) and perinatal death (33%). Pregnancy in women with cirrhosis while less common due to hypogonadism, is associated with additional potential complications of hepatic decompensation and encephalopathy (10%), hepatorenal syndrome, ascites and bacterial peritonitis. Pregnancy in women with cirrhotic portal hypertension is associated with maternal death in 1.6%, and fetal loss in 10–66%. We present a case of non-cirrhotic portal hypertension in pregnancy, discussing two other potential critical complications of portal hypertension in pregnancy, splenic artery aneurysm (SAA) and pulmonary hypertension.

Splenic artery aneurysm in pregnancy: A systematic review

“…Indeed, hypertension is a well-documented risk factor in the literature, as essential hypertension over time may weaken the splenic artery and predispose to an aneurysm. 7,17 As predicted, patients with a previous history of SAA are prone to forming further aneurysms because of pre-existing arterial wall weakness. 4,5 However, despite portal hypertension being a significant risk factor for SAA affecting 20%-50% of cases in non-pregnant women, 8 we only found one case of cirrhotic portal hypertension in an obstetric patient.…”

“…The next most common risk factors for SAA formation were history of previous SAA and hypertension. Indeed, hypertension is a well‐documented risk factor in the literature, as essential hypertension over time may weaken the splenic artery and predispose to an aneurysm 7,17 . As predicted, patients with a previous history of SAA are prone to forming further aneurysms because of pre‐existing arterial wall weakness 4,5 .…”

Hepatic cirrhosis with portal hypertension secondary to alpha-1 antitrypsin deficiency and autoimmune hepatitis in pregnancy: A case report

“…In cases of compensated cirrhosis with no evidence of portal hypertension, there is a lower risk of complications [3]. Cirrhosis with portal hypertension is associated with additional risks of hepatic decompensation and encephalopathy, ascites, hepatorenal syndrome and bacterial peritonitis [25]. Non-cirrhotic portal hypertension is not associated with reduced fertility, in contrast to cirrhotic portal hypertension [26].…”

A Rare Case of Portal Hypertension and Ascites Following Intrauterine Fetal Death: A Case Report

“…Other reasons include congenital portal vein abnormalities, schistosomiasis, and cancer [ 2 ]. Portal hypertension is rare in pregnancy and the postpartum period, and it is usually associated with preexisting liver disease, hypercoagulable states, or sepsis [ 3 ].…”