Int J Biol Med Res.

2023 ;14(2):7590-7591
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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

ARTICLE INFO ABSTRACT

Keywords:
Pregnancy with portal hypertension with splenectomy is an uncommon condition.It is seen that
Portal hypertension
maternal mortality is 2-18% ,hematemesis is seen in 20-30% and perinatal mortality is 11-
pregnancy
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.

c
Copyright 2010 BioMedSciDirect Publications IJBMR - ISSN: 0976:6685. All rights reserved.

Introduction

Portal hypertension is caused most often by cirrhosis (in Discussion

developed countries), schistosomiasis (in endemic areas), or
Prognosis of portal hypertension during pregnancy depends
hepatic vascular abnormalities. Consequences include esophageal
upon the underlying cause and the extent of derangement of liver
varices and portosystemic encephalopathy. Diagnosis is based on
function.Of the women with cirrhosis ,20-30% will have
clinical criteria, often in conjunction with imaging tests and
hematemesis during pregnancy with the mortality ranging
endoscopy. Prognosis of portal hypertension during pregnancy
between 50-60%.The incidence of hematemesis in patients with
depends upon the underlying cause and the extent of derangement
EHPVO and NCPF is around 7%.The timing and severity of
of liver function. Maternal prognosis is better with EHPVO and
hematemesis , however are unpredictable.Hematemesis is more
NCPF and poor with cirrhosis of the liver [2]. Maternal mortality
common in pregnancy complicated by varices [3].Hematemesis
ranges between 2% and 18%; being maximum with cirrhosis.
during pregnancy is contributed to by increased portal pressure
The causes of death are generally hematemesis, hepatic coma during pregnancy,reflux esophagitis and obstruction to the
or postpartum hemorrhage. Perinatal mortality ranges between inferior vena cava by the gravid uterus.
11% and 18%, mainly due to preterm delivery or intrauterine
Management of portal hypertension in pregnant women is
growth restriction (IUGR).
similar to that in non pregnant patients.Beta blockers are given to
Case report reduce portal venous pressures.There is a danger of variceal
rupture and hematemesis when the patient strains during labour
A 33 yr old elderly primigravida ,k/c/o chronic liver disease
[4].Patients with EHPVO and NCPF generally tolerate labor well
with portal hypertension and eosophageal varices came to gynae
and cesarean section is not mandatory.They must not be allowed
opd at 8 weeks of gestation for regular antenatal checkup.There
to bear down and the second stage should be cut short.
w a s n o h / o f e v e r, j a u n d i c e , h e m a t e m e s i s , b l e e d i n g
tendencies.Sonographic examination confirmed pregnancy and Pregnancy is not contraindicated in patients with portal
was adviced regular follow up.Repeat Usg level II scan was done at hypertension due to NCPF,EPVOC and compensated
20 weeks as fundal height came as more than the period of cirrhosis.Termination of pregnancy needs to be considered only in
ammenorrhoea.She came for regular follow up and all antenatal patients with decompensated cirrhosis,recurrent hematemesis
investigations done.The pregnancy proceeded and deranged liver functions,especially abnormal coagulation
uneventfully.Patient was on tab dytor(cat B),Tab inderal(cat C), profiles.The management of pregnancy with portal hypertension
should only be done at tertiary care centres by a multidisciplinary
The patient was taken up for emergency LSCS at 34 weeks
team with backup facilities for intensive care and blood
duration as NST was nonreactive and n alive female baby weighing
transfusion .
2.27kg was delivered.Post operative period went uneventful and
patient was discharged under satisfactory conditions.

* Corresponding Author : Dr Manpreet Anand

PG resident obs & gynae (3rd year) himalayan institute of medical s
ciences swami ram nagar doiwala dehradun
UTTARANCHAL, INDIA
sheena.2k2@gmail.com
c Copyright 2011. CurrentSciDirect Publications. IJBMR - All rights reserved.
 Anand Manpreet & Lal M, Srivastav A/ Int J Biol Med Res.14(2):7590-7591
7591

BIBLIOGRAPHY:
1] Pregnancy with portal hypertension, J of Obstet Gynecol, India Vol 57, No 3, 3]Britton RC.Pregnancy and esophageal varices.Am J Surg 1982;143:421-5
2007
4]Lee WM.Pregnancy in patients with chronic liver disease. Gastroenterol Clin
2] Cheng YS: Pregnancy in liver cirrhosis and/or portal hypertension. Am J Obstet North Am 1992;21:889-903
Gynecol 1977; 128: 812 – 21
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