Pregnancy with portal hypertension with splenectomy is an uncommon condition.It is seen that maternal mortality is 2-18% ,hematemesis is seen in 20-30% and perinatal mortality is 11-18% [1]. A number of patients with Extra hepatic portal venous obstruction (EHPVO) and non cirrhotic portal fibrosis (NCPF) are surviving to adult life. In patients with cirrhosis as long as liver function is relatively preserved pregnancy is possible.

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ARTICLE INFO ABSTRACT
Keywords:
Portal hypertension
pregnancy
Introduction
Portal hypertension is caused most often by cirrhosis (in
developed countries), schistosomiasis (in endemic areas), or
hepatic vascular abnormalities. Consequences include esophageal
varices and portosystemic encephalopathy. Diagnosis is based on
clinical criteria, often in conjunction with imaging tests and
endoscopy. Prognosis of portal hypertension during pregnancy
dependsupontheunderlyingcauseandtheextentofderangement
of liver function. Maternal prognosis is better with EHPVO and
NCPF and poor with cirrhosis of the liver [2]. Maternal mortality
rangesbetween2%and18%;beingmaximumwithcirrhosis.
The causes of death are generally hematemesis, hepatic coma
or postpartum hemorrhage. Perinatal mortality ranges between
11% and 18%, mainly due to preterm delivery or intrauterine
growthrestriction(IUGR).
Casereport
A 33 yr old elderly primigravida ,k/c/o chronic liver disease
with portal hypertension and eosophageal varices came to gynae
opd at 8 weeks of gestation for regular antenatal checkup.There
was no h/o fever,jaundice,hematemesis ,bleeding
tendencies.Sonographic examination confirmed pregnancy and
was adviced regular follow up.Repeat Usg level II scan was done at
20 weeks as fundal height came as more than the period of
ammenorrhoea.She came for regular follow up and all antenatal
i n v e s t i g a t i o n s d o n e . T h e p r e g n a n c y p r o c e e d e d
uneventfully.Patientwasontabdytor(catB),Tabinderal(catC),
The patient was taken up for emergency LSCS at 34 weeks
duration as NST was nonreactive and n alive female baby weighing
2.27kg was delivered.Post operative period went uneventful and
patientwasdischargedundersatisfactoryconditions.
Discussion
Prognosis of portal hypertension during pregnancy depends
upon the underlying cause and the extent of derangement of liver
function.Of the women with cirrhosis ,20-30% will have
hematemesis during pregnancy with the mortality ranging
between 50-60%.The incidence of hematemesis in patients with
EHPVO and NCPF is around 7%.The timing and severity of
hematemesis , however are unpredictable.Hematemesis is more
common in pregnancy complicated by varices [3].Hematemesis
during pregnancy is contributed to by increased portal pressure
during pregnancy,reflux esophagitis and obstruction to the
inferiorvenacavabythegraviduterus.
Management of portal hypertension in pregnant women is
similar to that in non pregnant patients.Beta blockers are given to
reduce portal venous pressures.There is a danger of variceal
rupture and hematemesis when the patient strains during labour
[4].Patients with EHPVO and NCPF generally tolerate labor well
and cesarean section is not mandatory.They must not be allowed
tobeardownandthesecondstageshouldbecutshort.
Pregnancy is not contraindicated in patients with portal
hypertension due to NCPF,EPVOC and compensated
cirrhosis.Termination of pregnancy needs to be considered only in
patients with decompensated cirrhosis,recurrent hematemesis
and deranged liver functions,especially abnormal coagulation
profiles.The management of pregnancy with portal hypertension
should only be done at tertiary care centres by a multidisciplinary
team with backup facilities for intensive care and blood
transfusion.
Pregnancywithportalhypertensionwithsplenectomyisanuncommoncondition.Itisseenthat
maternal mortality is 2-18% ,hematemesis is seen in 20-30% and perinatal mortality is 11-
18% [1]. A number of patients with Extra hepatic portal venous obstruction (EHPVO) and non
cirrhotic portal fibrosis (NCPF) are surviving to adult life. In patients with cirrhosis as long as
liverfunction isrelativelypreservedpregnancyispossible.
Case report
A Case of pregnancy with portal hypertension with splenectomy with oesophageal
varices
Anand Manpreet, Lal M, Srivastav A
PG resident obs & gynae (3rd year) himalayan institute of medical sciences swami ram nagar doiwala dehradun UTTARANCHAL, INDIA
* Corresponding Author :
PG resident obs & gynae (3rd year) himalayan institute of medical s
ciences swami ram nagar doiwala dehradun
UTTARANCHAL, INDIA
sheena.2k2@gmail.com
Dr Manpreet Anand
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2. 7591
BIBLIOGRAPHY:
1] Pregnancy with portal hypertension, J of Obstet Gynecol, India Vol 57, No 3,
2007
2] Cheng YS: Pregnancy in liver cirrhosis and/or portal hypertension. Am J Obstet
Gynecol1977;128:812–21
3]BrittonRC.Pregnancyandesophagealvarices.AmJSurg1982;143:421-5
4]Lee WM.Pregnancy in patients with chronic liver disease. Gastroenterol Clin
NorthAm1992;21:889-903
Anand Manpreet & Lal M, Srivastav A/ Int J Biol Med Res.14(2):7590-7591
All rights reserved.
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