title: [Primary biliary cirrhosis and pregnancy].
abstract: Primary biliary cirrhosis (PBC) is a chronic cholestatic liver disease, asymptomatic during a protracted time, characterized by changes in the small-sized bile ducts near portal spaces. The etiology of PBC is undefined, but immunologic and environmental disturbances may contribute to the disease. Infertility is often associated with PBC and cirrhosis, but pregnancy may well occur in women with PBC and without cirrhosis or in some others with compensated cirrhosis. A pluridisciplinary approach including gastroenterologists and obstetricians is recommended. The patient must be closely monitored throughout her pregnancy with maternal and routine antenatal care. Medical treatment requires ursodeoxycholic acid (UDCA). In non-cirrhotic UDCA-treated women with PBC, pregnancy often follows a normal course with vaginal delivery. In cirrhotic patients, UDCA must be continued during pregnancy, esophageal and gastric varices must be evaluated before pregnancy, and endoscopic ligature is recommended for treating large varices. Additionally, beta-blocker therapy may be associated, especially when variceal rupture occurred previously. Elective cesarean section is recommended in patients with large esophageal or gastric varices because of the potentially increased risk of variceal bleeding during maternal expulsive efforts in case of vaginal delivery.
authors.affiliation: Service de gynécologie obstétrique, centre hospitalier départemental, 85000 La Roche-sur-Yon, France. Electronic address: g.ducarme@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Ducarme
authors.affiliation: Fédération d'hépato-gastroentérologie, hôpital Beaujon, université Paris VII, Assistance publique-Hôpitaux de Paris (AP-HP), 100, boulevard du Général-Leclerc, 92110 Clichy, France.
authors.forename: J
authors.initials: J
authors.lastname: Bernuau
authors.affiliation: Service de gynécologie obstétrique, hôpital Beaujon, université Paris VII, Assistance publique-Hôpitaux de Paris (AP-HP), 100, boulevard du Général-Leclerc, 92110 Clichy, France.
authors.forename: D
authors.initials: D
authors.lastname: Luton
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D005298:Fertility / Q000502:physiology; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy
keywords: Cirrhose biliaire primitive; Grossesse; Management; Pregnancy; Primary biliary cirrhosis; Prise en charge