Lelei-Mailu Faith Jelagat, Mariara Charles Muriuki
Department of Family Medicine, AIC Kijabe Hospital, Kijabe, Kenya.
Department of Obstetrics and Gynaecology, AIC Kijabe Hospital, Kenya.
BMJ Case Rep. 2018 Mar 5;2018:bcr-2017-223076. doi: 10.1136/bcr-2017-223076.
This case report is of a 32-year-old woman of African descent on follow-up for pregnancy in the background of portal hypertension due to liver cirrhosis. She had initially been treated for chronic hepatitis B infection with lamivudine and tenofovir, complicated by portal hypertension and variceal bleeding that thrice required banding. Her pregnancy was uneventful until 31 weeks gestation when she presented with dyspnoea. On examination and investigation, she had oedema, bilateral pleural effusions and ascites. Multidisciplinary discussions involving surgery, anaesthesia, obstetrics, neonatology and medicine were held. A consensus outpatient and inpatient management plan was implemented. At 36 weeks, following non-reassuring fetal cardiotocography, she underwent induction of labour. An assisted vacuum delivery was conducted in a controlled setting. She gave birth to a live female infant who had an APGAR score of 9 at 5 min. Both she and the baby had an uneventful postpartum period.
本病例报告的是一名32岁的非洲裔女性，因肝硬化导致门静脉高压而在孕期接受随访。她最初因慢性乙型肝炎感染接受拉米夫定和替诺福韦治疗，并发门静脉高压和静脉曲张出血，曾三次接受套扎治疗。她的孕期一直顺利，直到妊娠31周时出现呼吸困难。经检查和调查，她有水肿、双侧胸腔积液和腹水。组织了包括外科、麻醉科、产科、新生儿科和内科的多学科讨论。实施了门诊和住院的共识管理计划。36周时，因胎儿心动图检查结果不理想，她接受了引产。在可控环境下进行了真空辅助分娩。她生下了一名活女婴，5分钟时阿氏评分9分。她和婴儿产后情况均良好。
