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Maternal–fetal outcome in pregnancies complicated with non-cirrhotic portal hypertension: experience from a Tertiary Centre in South India

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Abstract

Objective

To assess the maternal and perinatal outcomes of pregnant women with non-cirrhotic portal hypertension (NCPH).

Methods

This was an observational study done by retrieving the records of pregnant women with non-cirrhotic portal hypertension admitted to a tertiary hospital in South India, over a 9-year study period. Data regarding the clinical course, complications during pregnancy, labor, and delivery details were reviewed. We also compared the outcomes among women with non-cirrhotic portal fibrosis (NCPF) with extrahepatic portal vein obstruction (EHPVO).

Results

During the study period, portal hypertension was noted in 0.07%(n = 108) of the pregnancies and 74.1% of them had NCPH. The diagnosis was made for the first time in 54.7% of them when presented with pancytopenia or splenomegaly. Variceal bleeding complicated 25% of the pregnancies in women with NCPH pregnancies, with three among them having a massive bleed. Eighteen among them underwent endoscopy following bleeding; variceal banding procedure was performed in nine of them without any complications. Preterm birth was the most common (20.6%) obstetric complication. There was one maternal death from severe sepsis, acute kidney injury, and disseminated intravascular coagulation, following a massive variceal bleed. Obstetric outcomes and medical complications were similar in women with NCPF and EHPVO. Perinatal loss was comparable in both the groups (14.3% vs. 9.6%, p = 0.417)

Conclusion

Multidisciplinary team approach, with optimal and timely intervention with intensive monitoring, can reduce the morbidity and help achieve an optimal maternal–perinatal outcome in pregnancies complicated with portal hypertension.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Obstetrics& Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Dhanvantri Nagar, Pondicherry, 605006, India

    Anish Keepanasseril, Avantika Gupta, Devika Ramesh, Keerthana Kothandaraman, Yavana Suriya Jeganathan & Dilip Kumar Maurya

Authors
  1. Anish Keepanasseril
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  2. Avantika Gupta
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  3. Devika Ramesh
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  4. Keerthana Kothandaraman
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  5. Yavana Suriya Jeganathan
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  6. Dilip Kumar Maurya
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Contributions

AK, AG and DKM conceived the study. All authors contributed to the design. AG, DR, KK and YSJ carried out the data collection and guarantees data integrity. AK performed statistical analyses. AG and AK reviewed the analysis and AK and AG wrote the first draft. DR, KK, YSJ and DKM critically reviewed the draft. All authors contributed to revising and finalization of the manuscript. AK (corresponding author) guarantees all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Corresponding author

Correspondence to Anish Keepanasseril.

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Conflict of interest

Anish, Keepanasseril Avantika Gupta, Devika Ramesh, Keerthana Kothandaraman, Yavana Suriya Jeganathan and DilipKumar Maurya declare that they have no conflict of interest.

Ethical approval

This study was done as per the ethical standards set by the Institute Scientific Advisory and Ethical Committee (Human Studies), following the 1964 Helsinki declaration and its later amendments Since it was based on the records of the patients identified from the registers, waiver of consent and the protocol for the study was approved by the Institute Ethics Committee (Human Studies (Approval number: JIP/IEC/2016/24/808)).

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The written or oral informed consent was waived.

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Keepanasseril, A., Gupta, A., Ramesh, D. et al. Maternal–fetal outcome in pregnancies complicated with non-cirrhotic portal hypertension: experience from a Tertiary Centre in South India. Hepatol Int 14, 842–849 (2020). https://doi.org/10.1007/s12072-020-10067-5

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  • DOI: https://doi.org/10.1007/s12072-020-10067-5

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