title: Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients.
abstract: OBJECTIVE
  Complications of portal hypertension, such as variceal hemorrhage and ascites, are associated with significant increases in both mortality and complications during pregnancy. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure for treating portal hypertension, but the safety of TIPS during pregnancy is largely unknown. In this series, we review five patients who underwent TIPS placement while pregnant and describe their clinical outcomes.
  
  
  METHODS
  Five pregnant patients with cirrhosis and portal hypertension underwent elective TIPS for complications of portal hypertension (four for secondary prevention of variceal bleeding and one for refractory ascites). Outcomes measured were recurrent bleeding episodes or need for further paracenteses during pregnancy, estimated radiation dose to the fetus and gestational age at delivery. All patients were followed after delivery to evaluate technical and clinical success of the procedure.
  
  
  RESULTS
  All five patients survived pregnancy and went on to deliver successfully. When TIPS was performed for secondary prevention of variceal bleeding (n = 4), no patients demonstrated variceal bleeding after TIPS placement. When TIPS was performed for refractory ascites (n = 1), no further paracenteses were required. All patients delivered successfully, albeit prematurely. Average radiation dose estimated to the fetus was 16.3 mGy.
  
  
  CONCLUSIONS
  This series suggests that TIPS can be performed in selective pregnant patients with portal hypertension, with little added risk to the mother or fetus.
authors.affiliation: Department of Interventional Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195-7115, USA. cringra@uw.edu.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Ingraham
authors.affiliation: Department of Interventional Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195-7115, USA. spadia@uw.edu.
authors.forename: Siddharth A
authors.initials: SA
authors.lastname: Padia
authors.affiliation: Department of Interventional Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195-7115, USA. gej@uw.edu.
authors.forename: Guy E
authors.initials: GE
authors.lastname: Johnson
authors.affiliation: Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA. easter@uw.edu.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Easterling
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA. irisl@medicine.washington.edu.
authors.forename: Iris W
authors.initials: IW
authors.lastname: Liou
authors.affiliation: Physics Section, Department of Radiology, University of Washington, Seattle, WA, USA. kkanal@uw.edu.
authors.forename: Kalpana M
authors.initials: KM
authors.lastname: Kanal
authors.affiliation: Department of Interventional Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195-7115, USA. kvalji@uw.edu.
authors.forename: Karim
authors.initials: K
authors.lastname: Valji
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Portal hypertension; Pregnancy; Transjugular intrahepatic portosystemic shunt (TIPS)