Non-cirrhotic portal hypertension and pregnancy

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Non-cirrhotic portal hypertension (NCPH) is a fairly common disease. According to various sources, 15—25% of patients with NCPH are women of childbearing age who can become pregnant. The combination of portal hypertension and pregnancy can lead to severe complications that endanger the life of the mother and fetus. For a long time it was believed that pregnancy is contraindicated in patients with portal hypertension, in most cases, pregnancy was terminated. Currently, the approach to managing these patients has been revised, which has reduced the incidence of potentially life-threatening complications, one of which is bleeding from varicose veins of the esophagus and stomach.

Keywords:

extrahepatic portal hypertension

pregnancy

bleeding

thrombophilia

myeloproliferative disease

Authors:

Shchukina A.A.

Federal State Budgetary Scientific Institution «Petrovsky Russian Scientific Center of Surgery»;
Yeramishantsev City Clinical Hospital of the Department of Health of Moscow

Manukyan G.V.

Petrovsky Russian Research Center of Surgery

Alazhazhi M.

Yeramishantsev City Clinical Hospital of the Department of Health of Moscow

Kitsenko E.A.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-8268-3129

Received:

25.01.2022

Accepted:

13.02.2022

List of references:

Andrade F, Shukla A, Bureau C, Senzolo M, D’Alteroche L, Heurgué A, Garcia-Pagan JC, Turon F, Oberti F, Tripathi D, Roux O, Ceccaldi PF, de Raucourt E, Payancé A, Valla D, Plessier A, Rautou PE. Pregnancy in idiopathic non-cirrhotic portal hypertension: A multicentric study on maternal and fetal management and outcome. J Hepatol. 2018;69(6):1242-1249. https://doi.org/10.1016
Buyukbayrak EE, Ergen B, Karageyim Karsidag AY, Kars B, Turan C, Birtas Atesoglu E. Successful pregnancy in a patient with portal hypertension secondary to portal vein thrombosis due to essential thrombocythaemia: a rare case. J Maternal-Fetal Neonatal Med. 2010;23(2):187-189. https://doi.org/10.3109/14767050903067329
Vasil’eva ZV, Britvina KV, Kicenko EA. Pregnancy in women with portal hypertension. Rossiiskii vestnik akushera-ginekologa. 2011;11(5):42-45. (In Russ.).
Simcox LE, Ormesher L, Tower C, Greer IA Thrombophilia and Pregnancy Complications. Int J Mol Scie. 2015;16(12):28418-28428. https://doi.org/10.3390/ijms161226104
Anisha Ramniklal Gala, Tarakeswari Surapaneni, Nuzhat Aziz, Sailaja Devi KallurA Review of Outcomes in Pregnant Women with Portal Hypertension J Obstet Gynaecol India. 2018;68(6):447-451. https://doi.org/10.1007/s13224-017-1016-1
Eramishancev AK, Kicenko EA, Shercinger AG, Zhigalova SB. Bleeding from varicose veins of the esophagus and stomach: diagnosis, treatment tactics. Annaly khirurgicheskoi gepatologii. 2006;11(2):105-110. (In Russ.).
Khanna R, Sarin S Idiopathic portal hypertension and extrahepatic portal venous obstruction. Hepatol Intern. 2018;12(suppl 1):148-167. https://doi.org/10.1007/s12072-018-9844-3
Melikyan AL, Kovrigina AM, Subortseva IN, Shuvaev VA, Morozova EV, Lomaia EG, Afanasyev BV, Ageeva TA, Baikov VV, Vinogradova OYu, Gritsaev SV, Zaritskey AYu, Ionova TI, Kaplanov KD, Martynkevich IS, Mitina TA, Polushkina ES, Pospelova TI, Sokolova MA, Sudarikov AB, Turkina AG, Shatokhin YuV, Shmakov RG, Savchenko VG. National Clinical Guidelines on Diagnosis and Treatment of Ph-Negative Myeloproliferative Neoplasms (Polycythemia Vera, Essential Thrombocythemia, and Primary Myelofibrosis). Klinicheskaya oncohematologiay. 2021;14(2):262-298. (In Russ.).].
Smalberg JH, Arends LR, Valla DC, Kiladjian JJ, Janssen HL, Leebeek FW. Myeloproliferative neoplasms in Budd-Chiari syndrome and portal vein thrombosis: a meta-analysis. Blood. 2012;120(25):4921-4928. https://doi.org/10.1182/blood-2011-09-376517
Hoekstra J, Bresser EL, Smalberg JH, Spaander MC, Leebeek FW, Janssen HL Long-term follow-up of patients with portal vein thrombosis and myeloproliferative neoplasms. J Thromb Haemost. 2011;9(11):2208-2214. https://doi.org/10.1111/j.1538-7836.2011.04484.x
Hidaka M, Eguchi S.Budd-Chiari syndrome: Focus on surgical treatment. Hepatol Res. 2017;47(2):142-148. https://doi.org/10.1111/hepr.12752
Asif A, Hitawala, Vikas Gupta Budd Chiari Syndrome. StatPearls Publishing; 2022 Jan. 2021 Nov 20. https://doi.org/10.1007/springerreference_135450
Hernández-Gea V, De Gottardi A, Leebeek FWG, Rautou PE, Salem R, Garcia-Pagan JC. Current knowledge in pathophysiology and management of Budd-Chiari syndrome and non-cirrhotic non-tumoral splanchnic vein thrombosis. J Hepatol. 2019;71(1):175-199. https://doi.org/10.1016/j.jhep.2019.02.015
Makacarija AD, Bicadze VO, Hizroeva DH, Nemirovskij VB, Gadaeva ZK, Akin’shina SV. Thromboprophylaxis in pregnant women with a history of thrombophilia and thrombosis. Bjulleten’ SO RAMN. 2013;33(6):99-109. (In Russ.). https://doi.org/10.1515/jpm-2017-0329
Anisimov AJu, Vertkin AL, Devjatov AV, Dzidzava II, Zhigalova SB, Zatevahin II, Ivashkin VT, Kicenko EA, Lebezev VM, Manuk’jan GV. Practical recommendations for the treatment of bleeding from varicose veins of the esophagus and stomach. Adopted at the All-Russian conciliation conference on the adoption of the National clinical guidelines «Bleeding from the upper gastrointestinal tract». Voronezh, June 5—6, 2014. (In Russ.).
Sarin SK, Lahoti D, Saxena SP, Murthy NS, Makwana UK. Prevalence, classification and natural history of gastric varices: a long-term follow-up study in 568 portal hypertension patients. Hepatology. 1992;16(6):1343-1349. https://doi.org/10.1002/hep.1840160607.
Crocker A, Girling J, Cotzias C. Massive bleeding in pregnancy from ruptured oesophageal varices complicating portal hypertension: a cautionary tale. Obstet Med. 2011;4(4):169-70. https://doi.org/10.1258/om.2011.100075
Pol MM, Chawla LU, Rathore YS, Goel R Combined caesarean with splenectomy in pregnancy with portal hypertension: defining plausibility. BMJ Case report. 2017;2017. https://doi.org/10.1136/bcr-2017-220561
Dhingra M. Pregnancy with portal hypertension: a case report. Int J Reprod Contracept Obstet Gynecol. 2018;7(9):3896-3898. https://doi.org/10.18203/2320-1770.ijrcog20183818
Subbaiah M, Kumar S, Roy KK, Sharma JB, Singh N. Extrahepatic portal-vein obstruction in pregnancy. Taiwan J Obstet Gynecol. 2015;54(4):394-397. https://doi.org/10.1016/j.tjog.2013.11.012
Durivage A, Le Templier G, Cumyn A, Sauvé N. Pregnancy in a Woman with Latent Myeloproliferative Neoplasm Induced Chronic Portal Vein Thrombosis, Portal Cavernoma, and Gastric Varices. Case Rep Obstet Gynecol. 2019;2019:5702983. https://doi.org/10.1155/2019/5702983
Sandya MR, Manjula SK, Sr. Ancy MR. Pregnancy outcome in Non-cirrhotic portal hypertension. Int J Reprod Contracept Obstet Gynecol. 2017;6(10):4534-4537. https://doi.org/10.18203/2320-1770.ijrcog20174437
Sobral M, Granja C, Sampaio M, Guerreiro F. Bleeding from oesophageal varices in pregnancy. BMJ Case Rep. 2013;2013. https://doi.org/10.1136/bcr-2013-009653.
Aggarwal N, Chopra S, Raveendran A, Suri V, Dhiman RK, Chawla YK. Extra hepatic portal vein obstruction and pregnancy outcome: Largest reported experience. J Obstet Gynaecol Res. 2011;37(6):575-580. https://doi.org/10.1111/j.1447-0756.2010.01407.x
Khanna R, Sarin SK. Non-Cirrhotic Portal Hypertension — Diagnosis and Management. J Hepatol. 2014;60(2):421-441. https://doi.org/10.1016/j.jhep.2013.08.013
Donaldson LB, Plant RK. Pregnancy complicated by extrahepatic portal hypertension: review of literature and report of two cases. Am J Obstet Gynecol. 1971;110(2):255-264. https://doi.org/10.1016/0002-9378(71)90615-6
Lv Y, Li K, He C, Luo B, Zhang B, Liu H, Wang Z, Guo W, Wang Q, Chen H, Bai W, Yuan X, Yu T, Li X, Yuan J, Han N, Zhu Y, Niu J, Xie H, Wang J, Chen L, Yin Z, Fan D, Li Z, Han G TIPS for variceal bleeding in patients with idiopathic noncirrhotic portal hypertension: comparison with patients who have cirrhosis. Aliment Pharmacol Ther. 2019;49(7):926-939. https://doi.org/10.1111/apt.15186
Gioia S, Nardelli S, Ridola L, Riggio O. Causes and Management of Non-cirrhotic Portal Hypertension. Curr Gastroenterol Rep. 202017;22(12):56. https://doi.org/10.1007/s11894-020-00792-0
He FL, Qi RZ, Zhang YN, Zhang K, Zhu-Ge YZ, Wang M, Wang Y, Jia JD, Liu FQ Transjugular intrahepatic portosystemic shunt and splenectomy are more effective than endoscopic therapy for recurrent variceal bleeding in patients with idiopathic noncirrhotic portal hypertension. World J Clin Cases. 2020;8(10):1871-1877. https://doi.org/10.12998/wjcc.v8.i10.1871
Ingraham CR, Padia SA, Johnson GE, Easterling TR, Liou IW, Kanal KM, Valji K. Transjugular Intrahepatic Portosystemic Shunt Placement During Pregnancy: A Case Series of Five Patients. Cardiovasc Intervent Radiol. 2015;38(5):1205-1210. https://doi.org/10.1007/s00270-015-1053-z
Lodato F, Cappelli A, Montagnani M, Colecchia A, Festi D, Azzaroli F, Compagnone G, Cecinato P, Golfieri R, Mazzella G. Transjugular intrahepatic portosystemic shunt: a case report of rescue management of unrestrainable variceal bleeding in a pregnant woman. https://doi.org/10.1016/j.dld.2007.02.013
Paleti S, Nutalapati V, Fathallah J, Jeepalyam S, Rustagi T. Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) Versus Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Treatment of Gastric Varices Because of Portal Hypertension A Systematic Review and Meta-Analysis. J Clin Gastroenterol. 2020;54(7):655-660. https://doi.org/10.1097/MCG.0000000000001275

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