February 19th, 2020

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Pregnancy Complicated by Cirrhosis, Portal Hypertension, and Esophageal Varices: A Case Report
Authors:  Martin L. Gimovsky, M.D., Jigna K. Patel, M.D., Rebekah Valthaty, M.D., Karen L. Koscica, D.O., and Munir A. Nazir, M.D.
BACKGROUND: The coexistence of pregnancy and cirrhosis is rarely reported. Most patients with cirrhosis have metabolic pathology that interferes with ovulation and menses, and thus are likely to be infertile. Improvement in management of liver disorders has resulted in greater numbers of women with cirrhosis and related morbidities achieving pregnancy. When portal hypertension accompanies cirrhosis, the development of esophageal varices poses a particularly ominous threat to maternal and fetal well-being, particularly during antepartum and intrapartum periods. Life-threatening bleeding due to preexisting esophageal varices in the setting of portal hypertension based on cirrhosis is a complication during pregnancy and may result in maternal mortality rates of 10–50%.

CASE: A 28-year-old woman at 28 weeks’ gestation was referred to our institution for pregnancy complicated by cirrhosis, grade III esophageal varices, and portal hypertension. After consultation with Anesthesiology, Gastroenterology, and Hematology, it was decided to focus on prophylactic treatment while continuing the pregnancy. Propranolol was started as an outpatient, and when the patient presented with preterm premature rupture of membranes at 31+3 weeks and preterm labor, she was treated with ondansetron and omeprazole for GI prophylaxis.

CONCLUSION: When faced with pregnancy complicated by cirrhosis, portal hypertension, and/or esophageal varices, a multidisciplinary approach is an essential aspect in achieving optimal pregnancy outcome.
Keywords:  Cruveilhier-Baumgarten syndrome; esophageal and gastric varices; esophageal varices; esophageal varix; gastric varices; gastric varix; hypertension, portal; liver cirrhosis; pregnancy complications
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