title: Emergency cesarean delivery in primigravida with portal hypertension, esophageal varices, and preeclampsia.
abstract: The incidence of cirrhosis and advanced portal hypertension during pregnancy is very low, and the literature is scarce with regard to the anesthetic management of a parturient with this coexisting disease. We report the successful perioperative management of a parturi- ent with a history of cirrhosis and portal hypertension with esophageal varices and mild preeclampsia who presented at 38 weeks' gestation in active labor with a breech presentation requiring emergency cesarean delivery. She required endoscopic esophageal varices banding during the second trimester of pregnancy. After correction of her coagulopathy, she was administered subarachnoid block and cesarean delivery, which was conducted uneventfully. Anesthetic management of these patients depends on understanding and avoiding variceal hemorrhage, encephalopathy, renal failure, and careful fluid and electrolyte management.
authors.affiliation: Department of Anaesthesiology and Intensive Care, All India Instittue of Medical Sciences, New Delhi, India.
authors.forename: Puneet
authors.initials: P
authors.lastname: Khanna
authors.forename: Rakesh
authors.initials: R
authors.lastname: Garg
authors.forename: Kajari
authors.initials: K
authors.lastname: Roy
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Punj
authors.forename: Ravindra
authors.initials: R
authors.lastname: Pandey
authors.forename: Vanlal
authors.initials: V
authors.lastname: Darlong
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000451:nursing*; D001946:Breech Presentation; D002585:Cesarean Section / Q000451:nursing*; D004632:Emergency Medical Services / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008103:Liver Cirrhosis / Q000150:complications; D013527:Perioperative Nursing / Q000379:methods*; D011225:Pre-Eclampsia / Q000601:surgery*; D011247:Pregnancy; D016896:Treatment Outcome; D055815:Young Adult