title: Pregnancy and delivery in women with esophageal varices due to hepatic vein thrombosis.
abstract: OBJECTIVE
  Retrospective analysis of the course of pregnancy, labor and mode of anesthesia in women with portal hypertension and esophageal varices induced by portal vein thrombosis.
  
  
  METHODS
  From 2000 to 2012 seven pregnant were admitted. None had liver transplantation (Ltx), the varicose have been in the 1st stage. Each of them has been consulted by the obstetrician, transplant surgeon and anesthetist. The patient condition during pregnancy, labor and postpartum period was analyzed.
  
  
  RESULTS
  Pregnancy in five cases proceeded physiologically. In one threatening miscarriage was diagnosed and treated with gestagens, two patients had tocolytic. One required variceal banding twice. In three thrombocytopenia worsened, with platelet count <70 g/L (up to 59 g/L). They received platelet transfusion before delivery. In one case, significant hipoproteinemia (4.7 g/L) occurred. In a case, GDM G1 and oligohydramnios were found. All women delivered at term (37-40 Hbd). In all general anesthesia with the use of remifentanil was done. There were no fluctuations in MAP and HR. Incision to delivery time was 2.5 min. Time from opioid administration to birth was <4 min. All children were born in good condition, weight 10-90 percentile. Regional anesthesia is contraindicated in patients with thrombocytopenia. In patients with esophageal varices sudden increase in heart rate and blood pressure can cause hemorrhage.
  
  
  CONCLUSIONS
  Patients with portal hypertension can deliver at term. It is a high-risk pregnancy. In this group it is desirable to shorten the second stage of labor or complete it by c-section under general anesthesia with remifentanyl which allows getting desired analgesia without complications in the newborn. Surveillance of pregnant with portal hypertension must include monitoring of liver function and coagulation disorders.
authors.affiliation: 1st Department of Obstetrics and Gynecology .
authors.forename: Z
authors.initials: Z
authors.lastname: Jabiry-Zieniewicz
authors.forename: F A
authors.initials: FA
authors.lastname: Dabrowski
authors.forename: B
authors.initials: B
authors.lastname: Suchońska
authors.forename: R
authors.initials: R
authors.lastname: Kowalczyk
authors.forename: E
authors.initials: E
authors.lastname: Nowacka
authors.forename: B
authors.initials: B
authors.lastname: Kociszewska-Najman
authors.forename: B
authors.initials: B
authors.lastname: Pietrzak
authors.forename: P
authors.initials: P
authors.lastname: Malkowski
authors.forename: M
authors.initials: M
authors.lastname: Wielgos
mesh_terms: D001724:Birth Weight; D006502:Budd-Chiari Syndrome / Q000150:complications / Q000453:epidemiology*; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D004932:Esophageal and Gastric Varices / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000453:epidemiology; D007231:Infant, Newborn; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies
keywords: Delivery; hepatic vein thrombosis; remifentanyl; varicose veins