Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wisconsin; and the Division of Gastroenterology and Hepatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Obstet Gynecol. 2017 Jun;129(6):1118-1123. doi: 10.1097/AOG.0000000000002055.
To evaluate clinical characteristics and obstetric outcomes in pregnant women with liver cirrhosis.
This was a retrospective matched cohort study of women with liver cirrhosis between January 2005 and January 2016 in a university hospital. Women in a case group were matched to women in a control group according to year of delivery, age, body mass index, and parity in a 1:4 ratio. Bivariable and multivariable analyses were performed to compare the prevalence of the primary composite outcome, which included any one of the following: fetal or neonatal demise, placental abruption, preeclampsia, preterm delivery at less than 37 weeks of gestation, and small-for-gestational age neonate between women in the case group and those in the control group.
During the study period, the number of deliveries was approximately 110,000. Of these, 33 women with liver cirrhosis were identified, yielding an estimated frequency of cirrhosis of 1 per 3,333 pregnancies [95% confidence interval (CI) 3,313-3,353]. Thirty-one of these 33 women met all inclusion criteria. The most common etiology of cirrhosis was alcoholic liver disease. The rate of the primary outcome was 61% in women with cirrhosis and 12% in women in the control group. There were no cases of maternal death, and the livebirth rate was 97%. Women with cirrhosis were more likely to be non-Hispanic black, have chronic hypertension, and use alcohol. Multivariable logistic regression demonstrated that cirrhosis in pregnancy was associated with the composite outcome (adjusted odds ratio 9.4, 95% CI 3.4-26.2).
Despite lower rates of maternal and fetal mortality compared with earlier studies, pregnancy in women with liver cirrhosis is still associated with a high risk of adverse obstetric outcomes.
评估肝硬化孕妇的临床特征和产科结局。
这是一项回顾性匹配队列研究，纳入了 2005 年 1 月至 2016 年 1 月期间某大学医院的肝硬化孕妇。病例组患者按分娩年份、年龄、体重指数和产次以 1:4 的比例与对照组患者进行匹配。采用单变量和多变量分析比较病例组和对照组患者的主要复合结局（包括以下任何一种情况）的发生率：胎儿或新生儿死亡、胎盘早剥、子痫前期、妊娠 37 周前早产和小于胎龄儿。
研究期间，分娩总数约为 110000 例。其中，33 例孕妇诊断为肝硬化，肝硬化的估计发生率为每 3333 例妊娠 1 例（95%可信区间为 33133353）。这 33 例患者中有 31 例符合所有纳入标准。肝硬化最常见的病因是酒精性肝病。肝硬化组的主要结局发生率为 61%，对照组为 12%。无产妇死亡，活产率为 97%。肝硬化患者更可能是非西班牙裔黑人，患有慢性高血压并饮酒。多变量逻辑回归显示，妊娠合并肝硬化与复合结局相关（调整后的优势比为 9.4，95%可信区间为 3.426.2）。
与早期研究相比，尽管母婴死亡率较低，但妊娠合并肝硬化仍与不良产科结局风险增加相关。
