Pregnancy and delivery in women with esophageal varices due to hepatic vein thrombosis

Abstract

Patients with portal hypertension can deliver at term. It is a high-risk pregnancy. In this group it is desirable to shorten the second stage of labor or complete it by c-section under general anesthesia with remifentanyl which allows getting desired analgesia without complications in the newborn. Surveillance of pregnant with portal hypertension must include monitoring of liver function and coagulation disorders.

Potentially Grave Gastro-Intestinal Tract Problems in Pregnancy - A Challenge to the Obstetrician!

“…All patients were delivered by LSCS. 9 All the three patients in our study had a favourable outcome with two delivering vaginally. A good liaison between the obstetric and surgical gastroenterology team ensured a favourable outcome.…”

“…In another study, 7 patients were studied. 9 2 patients needed variceal banding multiple times and 3 had thrombocytopenia. All patients were delivered by LSCS.…”

Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases

“…Ultimately, mode of delivery should be guided by obstetric indications. (344,345) Postpartum hemorrhage risk is increased in women with cirrhosis, which may be related to underlying thrombocytopenia or higher rate of cesarean deliveries. (309) Prevention by active management of the third stage of labor is the mainstay of therapy.…”

Liver Disease During Pregnancy

“…Cross-sectional abdominal imaging should be deferred until after delivery with abdominal ultrasonography performed during pregnancy for hepatocellular carcinoma surveillance. Hepatocellular carcinoma in pregnancy may be associated with poorer obstetric outcomes with a 12.5% risk of spontaneous rupture and decreased maternal survival (1,48). Alphafetoprotein levels are typically elevated to some degree during pregnancy and thus are less helpful to use for surveillance.…”

“…The decision of continuing medical treatment throughout pregnancy in patients with cirrhosis for chronic liver conditions such as Wilson disease, hepatitis B, and autoimmune hepatitis should be made on a case-by-case basis to prevent an acute exacerbation of the underlying liver disease that could lead to acute-on-chronic liver failure. Portal vein thrombosis may present with abdominal pain and/or liver decompensation and should it occur would require anticoagulation and interventional radiologic consultation regarding the need for transjugular intrahepatic portosystemic shunt or other radiological procedures (48). The incidence of splenic artery aneurysms and their rupture are increased during pregnancy and are even higher in the setting of portal hypertension (1,3,27).…”