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VOLUME 10 , ISSUE 2 ( April-June, 2018 ) > List of Articles
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.
Published Online: 01-06-2018
Copyright Statement: Copyright © 2018; The Author(s).
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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