Pregnancy in liver cirrhosis. Assessment of maternal and fetal risks in eleven patients and review of the management.
Eleven patients with liver cirrhosis who had a pregnancy between 1974 and 1992 are reported. Prior to pregnancy 2 patients were splenectomized, 1 of them also had an unsuccessful mesocaval shunt and therefore underwent sclerotherapy. Furthermore, 3 patients were managed by injection sclerotherapy, 6 patients had episodes of hepatocellular failure and 5 had signs of hypersplenism. Gastrointestinal hemorrhage associated with pregnancy was noted in 6 patients. Jaundice was encountered in 2 patients, a raised bilirubin level in 3, ascites in 3, impairment of the synthetic liver function in 5, thrombocytopenia in 8, hemorrhagic diathesis in 5, and infectious puerperal complication in 5 patients. Esophageal sclerotherapy was used in 5 and transfusion in 6 patients. Of 12 births, 6 newborns were small-for-date and 1 of them died. Three neonates were preterm. Fetal wastage did not occur. The present data suggest that gastrointestinal hemorrhage in liver cirrhosis contributes to developing fetal growth retardation; cirrhotic patients can be prepared for pregnancy and the hematemesis during pregnancy can successfully be managed by esophageal sclerotherapy.
2nd Department of Obstetrics and Gynecology, Semmelweis Medical University, Budapest, Hungary.
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Pajor
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Lehoczky
D000328:Adult; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000150:complications / Q000628:therapy; D008423:Maternal Age; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015911:Sclerotherapy