Successful management of pregnancy in non-cirrhotic portal hypertension: a case report

Year 2015, Volume: 46 Issue: 3, 113 - 115, 22.06.2015

Yusuf Çakmak , Mehmet Şentürk , Ertuğrul Yılmaz , Mustafa Eroğlu , Özgür Tosun

Abstract

Introduction: The co-existence of pregnancy and liver disease is considered to be a rare and complex clinical situation. Besides pregnancy has specific complications even in a healthy liver, the previous liver damage associated to portal hypertension develops additional risks as a result of marked hemodynamic disturbances.

Case: We report the management of a pregnancy of a 22-year-old patient without additional complications beside NCPH and a history of prophylactic endoscopic ligation of esophageal varices. The pregnancy continued until term and cesarean section was performed successfully.

Conclusion: In non-cirrhotic portal hypertension (NCPH) the liver function is usually preserved, and the increased risk of bleeding from esophageal varices in pregnancy is open to debate.

Keywords

Liver disease, Pregnancy, Portal Hypertension

Non-sirotik portal hipertansiyonda gebeliğin başarılı yönetimi: olgu sunumu

Abstract

Giriş: Gebelik ve karaciğer hastalığı nadir ve karmaşık bir durum olarak ele alınır. Sağlıklı bir karaciğerde bile gebeliğe özgü komplikasyonların yanı sıra, önceki portal hipertansiyonuna bağlı karaciğer hasarı varlığı belirgin hemodinamik sorunlara yol açan ilave riskler geliştirir.

Olgu: 22 yaşında non-sirotik portal hipertansiyonlu profilaktik endoskopik varis ligasyonu yapılmış bir hastanın ek komplikasyon olmayan gebeliği sunulmuştur. Gebelik terme kadar sorunsuz izlenmiş ve başarılı bir sezaryen gerçekleştirilmiştir.

Sonuç: Non-sirotik portal hipertansiyonda karaciğer fonksiyonları genellikle korunur ve gebeliğe bağlı özofagus varis kanaması riskindeki artış tartışmaya açıktır. 

Keywords

Karaciğer Hastalıkları, Gebelik, Portal Hipertansiyon

References

• Larraín, S, Rinella, M, Glob. libr. women's med., (ISSN: 1756-2228) 2011; DOI 10.3843/GLOWM.10171
• Almashhrawi AA, Ahmed KT, Rahman RN, Hammoud GM, Ibdah JA. Liver diseases in pregnancy: diseases not unique to pregnancy. World J Gastroenterol. 2013 Nov 21;19(43):7630-7638
• López-Méndez E1, Avila-Escobedo L Pregnancy and portal hypertension a pathology view of physiologic changes. Ann Hepatol. 2006 Jul-Sep;5(3):219-23.
• Tan J, Surti B, Saab S. Pregnancy and cirrhosis. Liver Transpl 2008 Aug; 14(8):1081-91. Review.
• Russell MA, Craigo SD. Cirrhosis and portal hypertension in pregnancy. Semin Perinatol 1998; 22:156-165.
• Lee W: Pregnancy in patients with chronic liver disease. Gastroenterol Clin North Am 21: 889, 1992
• Hay JE: Liver disease in pregnancy. Hepatology. 2008 Mar;47(3):1067-76.
• Yip D, Baker A: Liver diseases and pregnancy. Clin Perinatol 12: 683, 1985
• Crickshank D, Wigton T, Hays P. Maternal physiology in pregnancy. In: Gabb S, Nieby J, Simpson J, editors. Obstetrics:normal and problem pregnancies. New York: Churchil Livingstone; 1996: 91-109
• Varma RR, Michelsohn NH, Borkowf HI, Lewis JD. Pregnancy in cirrhotic and noncirrhotic portal hypertension. Obstet Gynecol 1977; 50: 217–222.
• Pajor A, Lehoczky D. Pregnancy and extrahepatic portal hypertension. Review and report on the management. Gynecol Obstet Invest 1990; 30: 193–197.
• Kochhar R, Kumar S, Goel RC, Sriram PV, Goenka MK, Singh K. Pregnancy and its outcome in patients with noncirrhotic portal hypertension. Dig Dis Sci 1999; 44: 1356–1361.
• Aggarwal N, Sawhney H, Vasishta K, Dhiman RK, Chawla Y. Non-cirrhotic portal hypertension in pregnancy. Int J Gynaecol Obstet 2001; 72: 1–7.
• Misra S, Sanyal AJ. Pregnancy in a patient with portal hypertension. Clin Liver Dis 1999; 3:147-162.
• Sumana G, Dadhwal V, Deka D, Mittal S. Non-cirrhotic portal hypertension and pregnancy outcome. J Obstet Gynaecol Res 2008 Oct; 34:801-804.
• O’Mahony S. Endoscopy in pregnancy. Best Pract Res Clin Gastroenterol 2007; 21:893-899.
• Starkel P, Horsmans Y, Geubel A. Endoscopic band ligation: a safe technique to control bleeding esophageal varices in pregnancy. Gastrointestinal Endoscopy 1998; 48:212-214.
• De Franchis R. Evolving consensus in portal hypertension: Report of the Baveno IV Consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2005; 43: 167-76.
• Bosch J, García Pagán JC. Prevention of variceal rebleeding. Lancet 2003; 361: 952-954.
• Dhiman RK, Biswas R, Aggarwal N, Sawhney H, Chawla Y. Management of variceal bleeding in pregnancy with endoscopic variceal ligation and n-butyl 2-cyanoacrylate: Report of three cases. Gastrointest Endosc 2000; 51: 91-93.
• De Franchis R, Primignani M. Endoscopic treatments for portal hypertension. Semin Liver Dis 1999; 19: 439-55.