Pregnancy and vascular liver disease

Abstract

Vascular disorders of the liver frequently affect women of childbearing age. Pregnancy and the postpartum are prothrombotic states. Pregnancy seems to be a trigger for Budd-Chiari syndrome in patients with an underlying prothrombotic disorder. Whether pregnancy is a risk factor for other vascular liver disorders is unknown. In women with a known vascular liver disorder and a desire for pregnancy, stabilisation of the liver disease, including the use of a portal decompressive procedure when indicated, should be reached prior to conception. The presence of esophageal varices should be screened and adequate prophylaxis of bleeding applied in a manner similar to what is recommended for patients with cirrhosis. Most women likely benefit from anticoagulation during pregnancy and the postpartum. Labor and delivery are best managed by a multidisciplinary team with experience in this situation. Assisted vaginal delivery is the preferred mode of delivery. Although the risk of miscarriage and premature birth is heightened, current management of these diseases makes it very likely to see the birth of a live baby when pregnancy reaches 20 weeks of gestation.

Keywords: BCS, Budd–Chiari syndrome; Budd–Chiari syndrome; LMWH, low-molecular-weight heparin; MPD, myeloproliferative disorders; PVT, portal vein thrombosis; VKA, vitamin K antagonists; non-cirrhotic portal hypertension; portal vein thrombosis; pregnancy.

Figure 1

Coagulation changes in pregnancy.

Figure 2

Fetal outcome in pregnancies with known and treated portal vein thrombosis (left) or Budd–Chiari syndrome (right).

Figure 3

Management of women with vascular liver disease of childbearing age. Abbreviation: VLD: vascular liver disease.

Figure 4

Management of anticoagulation in women with vascular liver disease and a desire for pregnancy Abbreviation: LMWH: Low molecular weight heparin.