Pregnancy outcomes in women with Budd Chiari Syndrome before onset of symptoms and after treatment

Shukla, Akash; Sadalage, Abhishek; Gupta, Deepak; Gupte, Amit; Mahapatra, Anupam; Mazumder, Dipendu; Shah, Chirag; Modi, Tejas; Meshram, Megha; Dhore, Prashant; Bhatia, Shobna

doi:10.1111/liv.13552

Cited by 17 publications

(12 citation statements)

References 27 publications

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“…Underlying prothrombotic conditions were identified in almost all women with Budd-Chiari syndrome and portal vein thrombosis, which is in line with the up to 90% reported in previous studies. 4,11,21,22 Prophylactic or therapeutic doses of low-molecular-weight heparin during pregnancy and the postpartum period were given in all the women with Budd-Chiari syndrome and in the majority of women with portal vein thrombosis. Venous thrombosis, most notably pulmonary embolism, remains one of the leading causes of maternal morbidity during pregnancy in general, with an incidence of pregnancy-related venous thromboembolism ranging from 1 to 2 per 1000 deliveries.…”

Section: Discussionmentioning

confidence: 99%

“…Pregnancy as a risk factor could be identified in approximately 13% of Budd–Chiari syndrome patients in the few studies investigating this 9,10 . Women with Budd–Chiari syndrome have a higher incidence of primary infertility and adverse pregnancy outcomes compared with the general population 11 . Treatment of Budd–Chiari syndrome, including a portosystemic shunt or stent placement, may increase the probability of successful conception and pregnancy outcome 11–13 .…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy outcomes in women with Budd–Chiari syndrome or portal vein thrombosis – a multicentre retrospective cohort study

Wiegers

Hamulyák

Damhuis

et al. 2021

BJOG

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Objective To evaluate current practice and outcomes of pregnancy in women previously diagnosed with Budd–Chiari syndrome and/or portal vein thrombosis, with and without concomitant portal hypertension. Design and setting Multicentre retrospective cohort study between 2008 and 2021. Population Women who conceived in the predefined period after the diagnosis of Budd–Chiari syndrome and/or portal vein thrombosis. Methods and main outcome measures We collected data on diagnosis and clinical features. The primary outcomes were maternal mortality and live birth rate. Secondary outcomes included maternal, neonatal and obstetric complications. Results Forty‐five women (12 Budd–Chiari syndrome, 33 portal vein thrombosis; 76 pregnancies) were included. Underlying prothrombotic disorders were present in 23 of the 45 women (51%). Thirty‐eight women (84%) received low‐molecular‐weight heparin during pregnancy. Of 45 first pregnancies, 11 (24%) ended in pregnancy loss and 34 (76%) resulted in live birth of which 27 were at term (79% of live births and 60% of pregnancies). No maternal deaths were observed; one woman developed pulmonary embolism during pregnancy and two women (4%) had variceal bleeding requiring intervention. Conclusions The high number of term live births (79%) and lower than expected risk of pregnancy‐related maternal and neonatal morbidity in our cohort suggest that Budd–Chiari syndrome and/or portal vein thrombosis should not be considered as an absolute contraindication for pregnancy. Individualised, nuanced counselling and a multidisciplinary pregnancy surveillance approach are essential in this patient population. Tweetable abstract Budd–Chiari syndrome and/or portal vein thrombosis should not be considered as an absolute contraindication for pregnancy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes in women with Budd–Chiari syndrome or portal vein thrombosis – a multicentre retrospective cohort study

Wiegers

Hamulyák

Damhuis

et al. 2021

BJOG

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“…The main data on maternal and fetal risks of pregnancy in women with previously documented and treated BCS have been reported in two European and one Indian retrospective series including 55 pregnancies in 36 patients [17][18][19].…”

Section: Pregnancy In a Patient With Previously Recognized Budd-chiari Syndromementioning

confidence: 99%

“…In these surveys, carried out between 1985 and 2015, no maternal death was reported during a total of 55 pregnancies with a follow up of more than 30 months [17][18][19]. Forty three pregnancies occurred on anticoagulation therapy and 24 pregnancies were performed while radiological decompressive interventions had been performed before conception.…”

Section: Pregnancy In a Patient With Previously Recognized Budd-chiari Syndromementioning

confidence: 99%

Pregnancy in Vascular Liver Disease

Payancé

Rautou

Valla

2021

Vascular Disorders of the Liver

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BCS Budd Chiari syndrome HTT Hereditary hemorrhagic telangiectasia TIPS transjugular intrahepatic portosystemic shunt Among patients with Budd Chiari syndrome (BCS), portal vein thrombosis and porto-sinusoidal vascular disease, women of childbearing age account for 50%, 20% and 15%, respectively [1-3]. The affected women in this age have gained a long life expectancy since anticoagulation therapy, followed in specific cases by transjugular intrahepatic portosystemic shunt (TIPS), angioplasty or liver transplantation have been applied. Indeed, with an appropriate management, five-year survival rate is currently above 90% for women with BCS or portal vein thrombosis, and 85% for porto-sinusoidal vascular disease [1,2,4]. It is therefore not surprising that affected women with a well-controlled disease express a desire for pregnancy.

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“…A proportion of women with primary infertility and poor pregnancy outcomes can successfully bear children after effective therapy for BCS. 57 Previously, Rautou et al 58 had conducted a study on the outcomes of pregnancy in women with known and treated BCS and concluded that good maternal outcomes could be achieved with current treatment modalities and close surveillance of BCS. Therefore, BCS cannot be considered a contraindication to pregnancy in stable patients with treated and well-controlled disease.…”

Section: Table 13 Consensus Statements On Pregnancy With Cirrhosismentioning

confidence: 99%

Indian National Association for the Study of the Liver—Federation of Obstetric and Gynaecological Societies of India Position Statement on Management of Liver Diseases in Pregnancy

Arora

Kumar

Anand

et al. 2019

Journal of Clinical and Experimental Hepatology

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Liver diseases occurring during pregnancy can be serious and can progress rapidly, affecting outcomes for both the mother and fetus. They are a common cause of concern to an obstetrician and an important reason for referral to a hepatologist, gastroenterologist, or physician. Liver diseases during pregnancy can be divided into disorders unique to pregnancy, those coincidental with pregnancy, and preexisting liver diseases exacerbated by pregnancy. A rapid differential diagnosis between liver diseases related or unrelated to pregnancy is required so that specialist and urgent management of these conditions can be carried out. Specific Indian guidelines for

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Pregnancy outcomes in women with Budd Chiari Syndrome before onset of symptoms and after treatment

Abstract: Primary infertility is common and pregnancy outcomes are poor before the onset of symptoms in women with Budd-Chiari syndrome. Effective therapy of Budd-Chiari syndrome may improve fertility and pregnancy outcomes.

Cited by 17 publications

References 27 publications

Pregnancy outcomes in women with Budd–Chiari syndrome or portal vein thrombosis – a multicentre retrospective cohort study

Pregnancy outcomes in women with Budd–Chiari syndrome or portal vein thrombosis – a multicentre retrospective cohort study

Pregnancy in Vascular Liver Disease

Indian National Association for the Study of the Liver—Federation of Obstetric and Gynaecological Societies of India Position Statement on Management of Liver Diseases in Pregnancy

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