Ingraham Christopher R, Padia Siddharth A, Johnson Guy E, Easterling Thomas R, Liou Iris W, Kanal Kalpana M, Valji Karim
Department of Interventional Radiology, University of Washington, 1959 NE Pacific Street, Box 357115, Seattle, WA, 98195-7115, USA.
Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.
Cardiovasc Intervent Radiol. 2015 Oct;38(5):1205-10. doi: 10.1007/s00270-015-1053-z. Epub 2015 Jan 24.
Complications of portal hypertension, such as variceal hemorrhage and ascites, are associated with significant increases in both mortality and complications during pregnancy. Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established procedure for treating portal hypertension, but the safety of TIPS during pregnancy is largely unknown. In this series, we review five patients who underwent TIPS placement while pregnant and describe their clinical outcomes.
Five pregnant patients with cirrhosis and portal hypertension underwent elective TIPS for complications of portal hypertension (four for secondary prevention of variceal bleeding and one for refractory ascites). Outcomes measured were recurrent bleeding episodes or need for further paracenteses during pregnancy, estimated radiation dose to the fetus and gestational age at delivery. All patients were followed after delivery to evaluate technical and clinical success of the procedure.
All five patients survived pregnancy and went on to deliver successfully. When TIPS was performed for secondary prevention of variceal bleeding (n = 4), no patients demonstrated variceal bleeding after TIPS placement. When TIPS was performed for refractory ascites (n = 1), no further paracenteses were required. All patients delivered successfully, albeit prematurely. Average radiation dose estimated to the fetus was 16.3 mGy.
This series suggests that TIPS can be performed in selective pregnant patients with portal hypertension, with little added risk to the mother or fetus.
门静脉高压的并发症，如静脉曲张出血和腹水，与妊娠期间死亡率和并发症的显著增加相关。经颈静脉肝内门体分流术（TIPS）是一种成熟的治疗门静脉高压的方法，但TIPS在妊娠期间的安全性很大程度上未知。在本系列研究中，我们回顾了5例妊娠期间接受TIPS置入术的患者，并描述了她们的临床结局。
5例患有肝硬化和门静脉高压的妊娠患者因门静脉高压并发症接受了择期TIPS治疗（4例用于预防静脉曲张出血的二级预防，1例用于治疗难治性腹水）。测量的结局指标包括妊娠期间复发出血事件或进一步进行腹腔穿刺术的需求、胎儿估计辐射剂量和分娩时的孕周。所有患者在分娩后均接受随访，以评估该手术的技术和临床成功率。
所有5例患者均度过妊娠期并成功分娩。当TIPS用于预防静脉曲张出血的二级预防（n = 4）时，TIPS置入术后无患者出现静脉曲张出血。当TIPS用于治疗难治性腹水（n = 1）时，无需进一步进行腹腔穿刺术。所有患者均成功分娩，尽管为早产。估计胎儿的平均辐射剂量为16.3 mGy。
本系列研究表明，TIPS可在选择性门静脉高压妊娠患者中进行，对母亲或胎儿几乎没有额外风险。
