Maternal and perinatal outcome in patients with portal hypertension: A single-center experience.

Introduction Pregnancies in women with portal hypertension are characterized by increased maternal and perinatal complications. These include, among others, variceal bleeding, hepatic failure, and premature birth. As a result of improvement in care, pregnancies in this group of patients are on the rise. Our aim was to analyze the maternal and perinatal outcome of these high-risk pregnancies at our center, a level-3 university hospital.

Methods For the years 2013 to 2021 the term „portal hypertension“ was searched in our departmental database; here, all women booking for antenatal care are included, and relevant diagnoses are recorded. Patients’ notes were then retrieved for details of the medical history and maternal and perinatal data.

Results Eleven cases were identified. Details are listed in Table 1. With one exception all women had suffered complications of the underlying condition before the onset of pregnancy. Maternal complications during pregnancy, delivery and postpartum occurred in 72.7% of cases, with one life-threatening acute variceal bleeding in late pregnancy, resulting in emergency CS with simultaneous variceal banding, and one death two years after delivery as a result of complications after TIPS occlusion during the pregnancy. The CS rate was 72.7% (n=8); five of these were performed for fetal or obstetric indications. The preterm birth and NICU admission rate was high (56.5% and 45.5%, respectively). Birthweight was appropriate for GA with one exception (9th percentile). All patients were cared for by an interdisciplinary team of experts in obstetrics, prenatal medicine, hepatology, hematology, anesthesia, and intensive care.

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Discussion Our case series confirms the high maternal and perinatal complication rate associated with portal hypertension. Prevention of hemorrhagic and thromboembolic complications turned out to be the major challenge. Factors contributing to the high rate of this type of complications consist of (a) the presence of altered hemostasis secondary to the underlying condition; (b) the need for anticoagulation; (c) pregnancy-induced changes which include a decrease in platelet count; a procoagulatory state; an increased blood volume; a decreased peripheral vascular resistance; and a rise in the intraabdominal pressure. Preterm birth was the major perinatal complication occurring in our case series. Interdisciplinary care by a team of experts seems to be crucial for a successful maternal and perinatal outcome.

Publication History

Article published online:
26 November 2021