Pregnancy in Patients with Established Liver Cirrhosis – An Uncommon but High-Risk Situation

Marcus Robertson, Andrew Bathgate and Peter Hayes

Department of Hepatology, Royal Infirmary of Edinburgh, United Kingdom
Department of Gastroenterology, Monash Health, Melbourne, Australia

^*Correspondance to: Marcus Robertson 

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Abstract:

Pregnancy is uncommon in females with liver cirrhosis but represents a complicated and highrisk clinical situation. Cirrhosis and portal hypertension may significantly worsen during pregnancy placing both the mother and foetus at risk of serious adverse events. In women with pre-existing portal hypertension, 30% - 64% will suffer from liver-related complications during or after pregnancy, most commonly manifesting as either variceal haemorrhage or hepatic decompensation, with maternal mortality rates of 1.8% - 7.8%. The MELD score is the only risk stratification tool validated to accurately predict liver-related complications during pregnancy, with a pre-conception MELD score ≥10 indicating a very high-risk of serious liver-related complications. Management necessitates a multidisciplinary approach including a maternal-foetal medicine specialist, hepatologist, neonatologist and anaesthetist. All patients require endoscopy (either before pregnancy or in the second trimester) to assess for the development of varices.

Keywords:

Cirrhosis; Portal hypertension; Pregnancy; Varices; Variceal bleeding

Cite the Article:

Robertson M, Bathgate A, Hayes P. Pregnancy in Patients with Established Liver Cirrhosis � An Uncommon but High-Risk Situation. Ann Clin Case Rep. 2017; 2: 1426.