Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 10 , ISSUE 2 ( April-June, 2018 ) > List of Articles

CASE REPORT

Cirrhosis with Portal Hypertension in Pregnancy

Mrityunjay C Metgud, Swati S Goudar, Kamal P Patil

Keywords : Cirrhosis, Nephrotic syndrome, Pregnancy with portal hypertension

Citation Information : Metgud MC, Goudar SS, Patil KP. Cirrhosis with Portal Hypertension in Pregnancy. J South Asian Feder Obs Gynae 2018; 10 (2):134-137.

DOI: 10.5005/jp-journals-10006-1576

Published Online: 01-06-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Background: Conception is a rare event in women with cirrhosis with portal hypertension due to altered metabolism of sex steroids and malnutrition, provided the liver disease is well compensated. Maternal prognosis is better with extrahepatic portal venous obstruction (EHPVO) and noncirrhotic portal fibrosis (NCPF) and poor with cirrhosis of the liver. Maternal mortality ranges between 2 and 18%, being maximum with cirrhosis, whereas women with NCPF fare better with mortality rates between 2 and 6%. Perinatal mortality ranges between 11 and 18%, owing to preterm delivery or intrauterine growth restriction (IUGR). Nephrotic syndrome occurs in 0.012 to 0.025% of all pregnancies that add further insult to the uteroplacental insufficiency. Aim: In the light of advancement of modern obstetrics, the rising incidence of pregnancy with cirrhosis and portal hypertension is of common occurrence with today\'s obstetricians who should be well equipped to deal with the various adverse maternal and fetal outcomes associated with this condition in coordination with other specialty branches for holistic management of the case. Case report: A 35-year-old G3P1L1A1 known case of cirrhotic portal hypertension postsplenectomy 6 years earlier due to massive splenomegaly, severe anemia (pancytopenia) with immunoglobulin M (IgM) nephropathy, with previous baby having Down\'s syndrome presented at 20 weeks of gestation for further evaluation. Level II scan done was normal. Karyotyping of the fetus showed normal chromosomes. Upper gastroesophageal endoscopy done 2 years prior showed grade I esophageal varices. Ultrasonography abdomen showed heterogeneous echo texture of liver with cavernomatous transformation of the portal vein with extensive collaterals. The prognosis of this pregnancy was explained and continued with close monitoring with development of superimposed preeclampsia at 24 weeks of gestation. Urine routine and microscopy which showed albumin 3+, 80 to 100 pus cells, and 50 to 60 red blood cells with casts, with serum albumin in liver function test (LFT) being 1.5 at 34 weeks of gestation. She was taken up for elective lower segment cesarean section (LSCS) at 35 weeks of gestation in view of superimposed preeclampsia with IUGR and a live male baby of 1.97 kg was delivered. Conclusion: Patient had good pregnancy outcome despite having cirrhosis with portal hypertension and good renal function was achieved without steroids. Clinical significance: A multidisciplinary team approach in tertiary care center with availability of intensive care units is likely to yield best pregnancy outcome in pregnant women with cirrhosis and portal hypertension despite various associated complications.


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  1. Peitsidou A, Peitsidis P, Michopoulos S, Matsouka C, Kioses E. Exacerbation of liver cirrhosis in pregnancy: a complex emerging clinical situation. Arch Gynecol Obstet 2009 Jun;279(6): 911-913.
  2. Sowjanya R, Sudha R. Cirrhosis with portal hypertension in pregnancy. IOSR J Dent Med Sci 2015 Apr;14(4):10-11.
  3. Fagan, EA. Disorders of the liver, biliary system and pancreas. In: de Sweit M, editor. Medical disorders in obstetric practice. 4th ed. Oxford: Blackwell Science; 2002. p. 322.
  4. Aggarwal N, Negi N, Aggarwal A, Bodh V, Dhiman RK. Pregnancy with portal hypertension. J Clin Exp Hepatol 2014 Jun;4(2):163-171.
  5. Benjaminov FS, Heathcote J. Liver disease in pregnancy. Am J Gastroenterol 2004 Dec;99(12):2479-2488.
  6. Cheng YS. Pregnancy in liver cirrhosis and/or portal hypertension. Am J Obstet Gynecol 1977 Aug;128(7):812-822.
  7. Russell MA, Craigo SD. Cirrhosis and portal hypertension in pregnancy. Semin Perinatol 1998 Apr;22(2):156-165.
  8. Shaheen AA, Myers RP. The outcomes of pregnancy in patients with cirrhosis: population based study. Liver Int 2010 Feb;30(2):275-283.
  9. Aggarwal N, Sawhney H, Vasishta K, Dhiman RK, Chawla Y. Noncirrhotic portal hypertension in pregnancy. Int J Gynaecol Obstet 2001 Jan;72(1):1-7.
  10. Lee WM. Pregnancy in patients with chronic liver disease. Gastroenterol Clin North Am 1992 Dec;21(4):889-903.
  11. Pandya BK, Gibson SP, Robertson IG. Nephrotic syndrome in early pregnancy-is renal biopsy always necessary? Nephrol Dial Transplant 2002 Apr;17(4):672-674.
  12. Westbrook RH, Yeoman AD, O'Grady JG, Harrison PM, Delvin J, Heneghan MA. Model for end-stage liver disease score predicts outcome in cirrhotic patients during pregnancy. Clin Gastroenterol Hepatol 2011 Aug;9(8):694-699.
  13. O'Mahony S. Endoscopy in pregnancy. Best Pract Res Clin Gastroenterol 2007;21(5):893-899.
  14. de Franchis R; Baveno V faculty. Revising consensus in portal hypertension: report of Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010 Oct;53(4):762-768.
  15. Lodato F, Cappelli A, Montagnani M, Colecchia A, Festi D, Azzaroli F, Compagnone G, Cecinato P, Golfieri R, Mazzella G. Transjugular intrahepatic portosystemic shunt: a case report of rescue management of unrestrainable variceal bleeding in a pregnant woman. Dig Liver Dis 2008 May;40(5):387-390.
  16. Sarin SK, Sollano JD, Chawla YK, Amarapurkar D, Hamid S, Hashizume M, Jafri W, Kumar A, Kudo M, Lesmana LA, et al. Consensus on extra-hepatic portal vein obstruction. Liver Int 2006 Jun;26(5):512-519.
  17. Tran T, Ahn Joseph, Reau Nancy. ACG Clinical Guideline: Liver disease and Pregnancy. doi:10.1038/ajg.2015.430.
  18. Britton RC. Pregnancy and esophageal varices. Am J Surg 1982 Apr;143(4):421-425.
  19. Varma RR, Michelson NH, Borkowf HI, Lewis JD. Pregnancy in cirrhotic and non cirrhotic portal hypertension. Obstet Gynecol 1977 Aug;50(2):217-222.
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