title: Bleeding from oesophageal varices in pregnancy.
abstract: Bleeding from oesophageal varices is the most fearful event in pregnant women with cirrhosis and is the main cause of death in this group. Its approach and treatment are controversial, with ligation, sclerosis and β-blockers as possible choices. Follow-up must be multidisciplinary and delivery programmed because of the high risk of bleeding. Delivery route is also controversial. We present a case of a pregnant woman, with alcoholic cirrhosis and upper tract bleeding during the second trimester of pregnancy. She was submitted to an oesophagogastroduodenoscopy (OGD), which revealed varices grade II/III in the lower third of the oesophagus. She was transfused and was haemodynamically stable. It was decided not to start β-blockers. The pregnancy went well, with regular follow-up in obstetrics and hepatology. A deficiency of α-1 antitrypsin was detected. Delivery was programmed at 39 weeks of gestation, and a caesarean section was performed, with good maternal and fetal outcome.
authors.affiliation: Department of Serviço de Ginecologia, Hospital de Faro, EPE, Faro, Portugal. martasobral04@yahoo.com.br
authors.forename: Marta
authors.initials: M
authors.lastname: Sobral
authors.forename: Carla
authors.initials: C
authors.lastname: Granja
authors.forename: Margarida
authors.initials: M
authors.lastname: Sampaio
authors.forename: Fernando
authors.initials: F
authors.lastname: Guerreiro
mesh_terms: D000328:Adult; D017707:Erythrocyte Transfusion; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000628:therapy*; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods
references.citation: World J Gastroenterol. 2009 Feb 28;15(8):897-906
references.pmid: 19248187
references.citation: Am J Gastroenterol. 2008 Aug;103(8):2136-41; quiz 2142
references.pmid: 18796107
references.citation: Clin Gastroenterol Hepatol. 2005 Apr;3(4):390-6
references.pmid: 15822045
references.citation: Br J Anaesth. 1996 Feb;76(2):325-7
references.pmid: 8777122
references.citation: Semin Perinatol. 1998 Apr;22(2):156-65
references.pmid: 9638910
references.citation: Liver Transpl. 2008 Aug;14(8):1081-91
references.pmid: 18668664
references.citation: Best Pract Res Clin Gastroenterol. 2007;21(5):893-9
references.pmid: 17889814
references.citation: Hepatology. 2008 Mar;47(3):1067-76
references.pmid: 18265410