Pregnancy and cirrhosis

Negi

Journal of Clinical and Experimental Hepatology

et al. 2014

Even though pregnancy is rare with cirrhosis and advanced liver disease, but it may co-exist in the setting of noncirrhotic portal hypertension as liver function is preserved but whenever encountered together is a complex clinical dilemma. Pregnancy in a patient with portal hypertension presents a special challenge to the obstetrician as so-called physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal hemorrhage. Risks of variceal bleed and hepatic decompensation increase many fold during pregnancy. Optimal management revolves round managing the portal hypertension and its complications. Thus management of such cases requires multi-speciality approach involving obstetricians experienced in dealing with high risk cases, hepatologists, anesthetists and neonatologists. With advancement in medical field, pregnancy is not contra-indicated in these women, as was previously believed. This article focuses on the different aspects of pregnancy with portal hypertension with special emphasis on specific cause wise treatment options to decrease the variceal bleed and hepatic decompensation. Based on extensive review of literature, management from pre-conceptional period to postpartum is outlined in order to have optimal maternal and perinatal outcomes. ( J CLIN EXP HEPATOL 2014;4:163-171) P regnancy associated with liver diseases is an infrequent situation, but when seen together, presents a complicated clinical situation. Portal hypertension develops as a result of number of etiologies. In the west, cirrhosis is the commonest cause of portal hypertension. In the setting of cirrhotic portal hypertension, pregnancy is very rare due to hepatocellular damage leading to amenorrhea and infertility, the incidence of cirrhosis in pregnancy has been reported as 1 in 5950 pregnancies. 1 Cirrhosis may get exacerbated during pregnancy and has significant adverse effects on the mother and the baby. [2][3][4] In the developing countries, other causes like extrahepatic portal vein obstruction contribute significantly to noncirrhotic portal hypertension (NCPH). Mostly liver function is much better preserved in women with NCPH and pregnancy is spontaneous in these women. Portal hypertension associated with pregnancy is a high risk situation as both pregnancy and portal hypertension share some of the hemodynamic changes. The physiological changes, in adaptation to the pregnancy and fetal needs, worsen the portal hypertension resulting in potentially life-threatening variceal bleed and other complications. Pregnancy is a potential hazard for occurrence of recurrent variceal bleed due to its hyperdynamic state causing increase in flow to the collaterals. 5-7 Therefore management in pregnancy requires knowledge of both the effects of changes during pregnancy on portal hemodynamics and the effects of portal hypertension and its cause on both mother and fetus, hepatotoxic...

Section: Esophageal Varicesmentioning

confidence: 99%

“…19 Successful pregnancies have been reported after liver transplant. [61][62][63][64][65][66] In the National Transplant Registry from USA, 202 pregnancies have been reported in 121 liver transplant recipients.…”

Section: Pregnancy After Liver Transplantationmentioning

confidence: 99%

Pregnancy with Portal Hypertension

Negi

Journal of Clinical and Experimental Hepatology

et al. 2014

“…80 L'incidenza di CP negli Stati Uniti varia da 1 ogni 1000 a 1 ogni 4000 nati vivi. 72,74,76 Tuttavia ci sono alcuni luoghi dove l'incidenza è particolarmente elevata: in Haiti l'incidenza è di 1 ogni 300 nati vivi 81 e questa differenza potrebbe essere dovuta a differenze raziali, malnutrizione o alta prevalenza di eclampsia. Nelle regioni più a nord della Nigeria l'incidenza si attesta a 1 ogni 100 nati vivi.…”

Section: Epidemiologia Della Cardiomiopatia Peripartumunclassified

“…81 L'ALD porta ad anovulazione e amenorrea con riduzione della fertilità. 82 Quando inizia comunque una gravidanza in una donna cirrotica, il tasso di aborti spontanei, il rischio di prematurità e il tasso di mortalità perinatale sono tutti aumentati.…”

Section: Epatopatia Alcolicaunclassified

Problematiche internistiche in corso di gravidanza

2017

<img src="/public/site/images/pgranata/rass.jpg" alt="" /> L’internista in ostetricia V. Donvito, A. Maina, L. Balbi, D. ManfellottoTromboembolismo venoso in gravidanza A. Fontanella, M. Gino Cardiopatie e gravidanza R. Gerloni, D. Panuccio Ipertensione arteriosa in gravidanza e preeclampsia F. Saladini, N. Lazzarin, D. ManfellottoTrombocitopenia in gravidanza R. Mestroni, A. CivardiMalattie broncopolmonari in gravidanza Gravidanza ed apparato respiratorio in fisiologia e patologia O. Para, A. SacchettaManagement del diabete mellito in gravidanza Parte 1: Gestante con diabete pregravidico I. Ambrosino, T.M. Attardo, G. AugelloManagement del diabete mellito in gravidanza Parte 2: Il diabete mellito gestazionale T.M. Attardo, I. Ambrosino, G. AugelloTireopatie in gravidanza E. BarbagelataMalattie del fegato e gravidanza P. Crispino, L. Fontanella, M. Visconti, P. GnerreHyperemesis gravidarum M.S. Montini, P. GnerreBatteriuria asintomatica e infezioni delle vie urinarie sintomatiche in gravidanza P. Gnerre, M. GiustiTerapia antibiotica in gravidanza P. Gnerre, M. GiustiConclusioni: Learning points per chi richiede (e per chi esegue) la consulenza G. Pinna, R. Re

“…По некоторым данным, она оценивается как 45 слу-чаев на 100 000 женщин репродуктив-ного возраста [3]. Главной причиной этого являются метаболические и гор-мональные нарушения, которые ведут к ановуляции и аменорее.…”

unclassified

Viral hepatitis in women of reproductive age

Зайцев

2017

A considerable number of various liver diseases that are associated with the course of pregnancy are quite common and occur at least three percent of pregnant women.This pathology plays an important role and is one of the most important reasons for the development of a wide range of different pathologies in pregnant women, in fetuses and newborns. The problem of changing functional liver tests during pregnancy acquires special sharpness and significance in connection with the not-so-recent role of liver pathology in mortality in maternal and perinatal mortality.In recent years, based on a large number of observations and statistical data, important information has been obtained on the details of the mechanism of this pathology, developed and refined diagnostic methods, as well as detailed schemes for treating liver diseases in pregnant women at different stages of pregnancy. Collected and scrupulously processed extensive data on the change in a variety of functional liver tests at various stages of pregnancy, both under normal and with complicated flow.Particular attention is paid to such pathology as preeclampsia, eclampsia, acute fatty liver disease of pregnant women, HELLP syndrome, intrahepatic cholestasis of pregnant women, uncontrollable vomiting of pregnant women, liver rupture, in the diagnosis of which one of the leading, decisive roles is assigned to the change in functional liver tests.In our review, the main emphasis was made in the direction of changing various significant indicators of functional hepatic tests in pregnant women both in physiologically developing pregnancy and in various liver diseases, both as a consequence of pregnancy and not directly related to it. The article also highlights the main mechanisms of these changes. The publication provides the latest information on the timing of full or partial normalization of a wide range of functional liver tests both after delivery and in the natural course of the disease.