Pregnancy with portal hypertension: a case report
Even though pregnancy is rare with cirrhosis and advanced liver disease, it may co-exist in the setting of noncirrhotic portal hypertension as liver function is preserved. When encountered together it presents a complex clinical dilemma. Physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal haemorrhage.

Published in the International Journal of Reproduction, Contraception, Obstetrics and Gynecology, through this case report of a 23 year old primigravida with Non Cirrhotic portal hypertension with 33 weeks gestational age in preterm labor the authors intend to focus upon different aspects of pregnancy with portal hypertension, its complications and management strategies.

A 23 year old patient, primigravida with 33 weeks gestational age, known case of non-cirrhotic portal hypertension reported in labour room in preterm labour. The patient gave history of 2 episodes of hematemesis 6 months prior to conception. Endoscopy done preconceptionally showed grade 3 varices, ultrasonography done at that time showed hepatomegaly without distortion of liver architecture, massive splenomegaly, dilatation of portal collaterals, absence of ascites and a single live intrauterine gestation corresponding to the gestational age.

In the present pregnancy, there was no history bleeding tendencies, jaundice. liver function tests, coagulation profile were normal. Markers of infective hepatitis were negative . Pancytopenia was present. Patient was allowed for spontaneous progress of labour, started on antenatal corticosteroids, Tab propranolol 20 mg three times a day (after consultation with the gastroenterologists). High risk consent was taken in view of prematurity, risk of variceal bleeding, pancytopenia, need of blood and blood products.

Adequate amount of blood and plasma were arranged. The second stage of labour was cut short by instrumental delivery. Patient delivered a 1.5 kg male baby that cried immediately after birth and was shifted to nursery for observation. Third stage of labour was managed actively. Postpartum recovery was uneventful.

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