Vnitr Lek 2021, 67(3):e28-e32 | DOI: 10.36290/vnl.2021.048

Liver cirrhosis and pregnancy: a case report and review of literature

Veronika Zvárová^{1, 2}, Jiří Dolina^{1, 2}, Michal Šenkyřík^{1, 2}, Radek Kroupa^{1, 2}, Lubomíra Horňáková^{1, 2}, Petr Jabandžiev^{2, 3, 4}, Štěpán Hrabovský^{2, 5}, Marta Číhalová^{2, 6}, Jakub Hustý^{2, 7}, Kornelia Mytsak², Lumír Kunovský^{1, 2, 8}

¹ Department of Gastroenterology and Internal Medicine, University Hospital Brno, Czech Republic

² Faculty of Medicine, Masaryk University, Brno, Czech Republic

³ Department of Pediatrics, University Hospital Brno, Czech Republic

⁴ Central European Institute of Technology, Masaryk University, Brno, Czech Republic

⁵ Department of Hematology, Oncology and Internal Medicine, University Hospital Brno, Czech Republic

⁶ Department of Pathology, University Hospital Brno, Czech Republic

⁷ Department of Radiology and Nuclear Medicine, University Hospital Brno, Czech Republic

⁸ Department of Surgery, University Hospital Brno, Czech Republic

Liver cirrhosis is a chronic liver disease in which the liver tissue and the vascular beds are remodeled leading to impaired hepatic function. Portal hypertension and subsequent esophageal varices are a frequent complication of liver cirrhosis and are a cause of mortality in patients with liver cirrhosis. Pregnancy in women with liver cirrhosis is uncommon, the incidence being about 1 in 5 950 pregnancies. Hepatocellular damage and the associated alteration in the metabolism of the sex hormones is thought to be responsible and leads to anovulation. In spite of all these factors, women with cirrhosis can and do become pregnant. Pregnancy is successful in most of the patients with chronic liver disease, but maternal and fetal complication rates are still high for decompensated liver cirrhosis. Portal hypertension associated with pregnancy is a high-risk situation as both pregnancy and portal hypertension share some of the hemodynamic changes. Risks of variceal bleeding and hepatic decompensation increases many fold during pregnancy. Despite the possible complications mentioned above, the maternal-fetal morbidity and mortality rates have been decreased by the current developments in hepatology, prevention of bleeding from varices with drugs and/or endoscopic variceal ligation, improvement in liver transplantation, and an increased experience in these issues.

Keywords: pregnancy, gravidity, liver, cirrhosis, varices, transjugular intrahepatic portosystemic shunt, lymphoma.

Published: May 26, 2021  Show citation