Portal hypertension in pregnancy

Savaş Karakuş; Şerife Özlem Genç; Dilay Karademir; Buğra Oksasoğlu; Gamze Sönmez; Yasemin Albak; Erol Çakmak; Meral Çetin

doi:10.7197/223.vi.553447

EN

Portal hypertension in pregnancy

Abstract

Objective: We aimed to revise the pregnancy and portal hypertension approach which is rarely seen together and may cause bleeding in esophageal varices.

Case Report: A 35-year-old patient with portal hypertension at 38 weeks of gestation according to first trimestr ultrasonography (USG) was admitted to our clinic. At the age of 16, she was diagnosed with liver biopsy. She had had two vaginal births before. The patient did not have 2nd and 3rd trimester screening tests. The detailed USG was normal. The abdominal USG had a liver size of 14.5 cm. Hepatic venules and portal venous diameter were 8.2 mm at the level of the liver hilus. Spleen size was 14.5 cm. In the vicinity of the splenic hilus, the widest 13 mm diameter tortuous veins were observed. A council consisting of Gynecology, Gastroenterology and Neonatology team at 32nd week of pregnancy it was suggested that clinical and laboratory findings were closely followed and vaginal delivery was recommended unless there was an obstetric problem. The pregnancy was terminated by cesarean section because acute fetal distress developed when she was followed on the travay when she applied at 38th gestational week. Meconium 2420 gr 48 cm Apgar score 6/8 male baby was born.

Conclusions: Portal hypertension is defined as elevation of blood pressure in the portal vein and its branches over 200-230 mmH2O. Portal hypertension and pregnancy can rarely be confronted. It increases the mortality and morbidity of the baby and the mother. Portal hypertension does not constitute a contraindication to pregnancy. During pregnancy, esophageal variceal bleeding, premature delivery, intrauterine growth restriction and fetal death can occur. In our case, we had a baby born with low birth weight who had cesarean section for an obstetric cause. As a result, the management of complications caused by portal hypertension during pregnancy is similar to that in non-pregnant patients, but a more intensive monitoring and follow-up is necessary.

Keywords

intrauterin growth restriction,pregnancy,portal hypertension

Kaynakça

1. Sarin SK, Kapoor D. Non-cirrhotic portal fibrosis: current concepts and management. J GastroenterolHepatol 2002; 17: 526–534.
2. Okuda K. Non-cirrhotic portal hypertension: why is it so common in India? J Gastroenterol Hepatol 2002; 17: 1–5.
3. Benhamou JP, Valla DC. Intrahepatic portal hypertension. In: Bircher J, Benhamou JP, McIntyre N, et al, eds. Oxford Textbook of Clinical Hepatology. 2nd ed.Oxford: Oxford University Press, 1999. p.661–670.
4. Shaheen A A, Mayers RP. The outcomes of pregnancy in patients with cirrhosis: a population-based study. Liver Int 2010;30: 275-283.
5. Britton RC. Pregnancy and esophageal varices. Am J Surg 1982;143:421-425. 6. Pajor A, Lehoczky D. Pregnancy and extrahepatic portal hypertension. Gynecol Obstet Invest 1990;30: 193-197.
7. Tan J, Surti B, Saab S. Pregnancy and cirrhosis. Liver Transpl 2008;14: 1081-1091.
8. Starkel P, Horsmans Y, Geubel A. Endoscopic band ligation: a safe technique to control bleeding esophageal varices in pregnancy. Gastrointest Endosc 1998;48: 212-214.
9. Misra S, Sanyal AJ. Pregnancy in a patient with portal hypertension. Clin Liver Dis 1999;3: 147-162.