title: Extrahepatic portal-vein obstruction in pregnancy.
abstract: BACKGROUND
  Extrahepatic portal-vein obstruction (EHPVO) is a common cause of portal hypertension in developing countries. The main risk in pregnant women with this condition is variceal bleeding, which may be life-threatening. The objective of our study was to assess the outcome of pregnancy in women with EHPVO.
  
  
  METHODS
  A retrospective analysis of 21 pregnancies in 12 women with EHPVO was carried out at a tertiary hospital in India.
  
  
  RESULTS
  The mean age of pregnant women with EHPVO was 25.3 years, and the mean duration of disease since diagnosis was 6.1 ± 1.2 years. All the patients had chronic EHPVO, and two patients were diagnosed in the index pregnancy. The incidence of abortion, preterm deliveries, and small for gestational age fetus was 23.8%, 18.7%, and 12.5%, respectively. Thrombocytopenia was found to complicate 61.9% of the pregnancies, while anemia was detected in 40% of the pregnancies. Variceal bleeding occurred in one woman, who was diagnosed during pregnancy and was managed successfully with endoscopic sclerotherapy. None of the patients who were diagnosed prenatally had variceal bleeding during pregnancy. The outcome in nine pregnancies, in which prenatal endoscopic variceal ligation was done, was compared with eight pregnancies, in which endoscopic sclerotherapy was done. No significant difference between the two groups in terms of pregnancy outcome and complications was found. There were no stillbirths or maternal mortality.
  
  
  CONCLUSIONS
  Women with EHPVO who have been diagnosed and treated prenatally have a good pregnancy outcome. They should be managed in a tertiary care center with a multidisciplinary approach.
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: muralidraiims@gmail.com.
authors.forename: Murali
authors.initials: M
authors.lastname: Subbaiah
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sunesh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Kallol Kumar
authors.initials: KK
authors.lastname: Roy
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Jai Bhagwan
authors.initials: JB
authors.lastname: Sharma
authors.affiliation: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Neeta
authors.initials: N
authors.lastname: Singh
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003906:Developing Countries; D004932:Esophageal and Gastric Varices / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D005865:Gestational Age; D006504:Hepatic Veno-Occlusive Disease / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000175:diagnosis; D007194:India; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015911:Sclerotherapy / Q000379:methods; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: endoscopic sclerotherapy; endoscopic variceal ligation; extrahepatic portal-vein obstruction; pregnancy outcome; variceal bleed