Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Puducherry, 605006, India.
Department of Biostatistics, Jawaharlal Institute of Post-Graduate Medical Education and Research (JIPMER), Puducherry, 605006, India.
Hepatol Int. 2023 Feb;17(1):170-179. doi: 10.1007/s12072-022-10385-w. Epub 2022 Jul 8.
Portal hypertension is secondary to either cirrhotic or non-cirrhotic causes, and complicating pregnancy poses a challenge to the treating team. A systematic review was performed to determine maternal and perinatal outcomes in women with portal hypertension. Outcomes were compared among those with cirrhotic (CPH) with non-cirrhotic portal hypertension (NCPH) as well as non-cirrhotic portal fibrosis (NCPF) with extra-hepatic portal vein obstruction (EHPVO).
Medline and EMBASE databases were searched for studies reporting outcomes among pregnant women with portal hypertension. Reference lists from relevant papers and reviews were hand-searched for appropriate citations. Data were extracted to describe maternal complications, obstetric and neonatal outcomes. A random-effects model was used to derive pooled estimates of various outcomes, and final estimates were reported as percentages with a 95% confidence interval (CI). Cumulative, sequential and sensitivity analysis was studied to assess the temporal trends of outcomes over the period.
Information on 895 pregnancies among 581 patients with portal hypertension was included from 26 studies. Portal hypertension was diagnosed during pregnancy in 10% (95% CI 4-24%). There were 22 maternal deaths (0%, 95% CI 0-1%), mostly following complications from variceal bleeding or hepatic decompensation. Variceal bleeding complicated in 14% (95% CI 9-20%), and endoscopic interventions were performed in 12% (95% CI 8-17%) during pregnancy. Decompensation of liver function occurred in 7% (95% CI 3-12%). Thrombocytopenia was the most common complication (41%, 95% CI 23-60%). Miscarriages occurred in 14% (95% CI 8-20%), preterm birth in 27% (95% CI 19-37%), and low birth weights in 22% (95% CI 15-30%). Risk of postpartum hemorrhage was higher (RR 5.09, 95% CI 1.84-14.12), and variceal bleeding was lower (RR 0.51, 95% CI 0.30-0.86) among those with CPH compared to NCPH. Risk of various outcomes was comparable between NCPF and EHPVO.
One in ten pregnancies complicated with portal hypertension is diagnosed during pregnancy, and thrombocytopenia is the most common complication. Hepatic decompensation and variceal bleeding remain the most common cause of maternal deaths, with reduced rates of bleeding and its complications reported following the introduction of endoscopic procedures during pregnancy. CPH increases the risk of postpartum hemorrhage, whereas variceal bleeding is higher among NCPH.
门静脉高压症继发于肝硬化或非肝硬化原因，妊娠合并门静脉高压症给治疗团队带来了挑战。进行了系统评价，以确定患有门静脉高压症的女性的母婴结局。将肝硬化（CPH）与非肝硬化性门静脉高压症（NCPH）以及非肝硬化性门静脉纤维化（NCPF）与肝外门静脉阻塞（EHPVO）患者的结果进行了比较。
在 Medline 和 EMBASE 数据库中搜索报告了患有门静脉高压症的孕妇结局的研究。从相关论文和综述的参考文献中手动搜索适当的引文。提取数据以描述母婴并发症、产科和新生儿结局。使用随机效应模型得出各种结局的汇总估计值，并以百分比（95%置信区间[CI]）报告最终估计值。进行了累积、顺序和敏感性分析，以评估在此期间结局的时间趋势。
纳入了 26 项研究中 581 名患有门静脉高压症患者的 895 例妊娠信息。10%（95%CI 4-24%）的孕妇在怀孕期间被诊断为门静脉高压症。有 22 例母亲死亡（0%，95%CI 0-1%），主要是由于静脉曲张出血或肝功能失代偿引起的并发症所致。静脉曲张出血在 14%（95%CI 9-20%）中并发，怀孕期间进行了内镜干预治疗 12%（95%CI 8-17%）。肝功能失代偿发生率为 7%（95%CI 3-12%）。血小板减少是最常见的并发症（41%，95%CI 23-60%）。流产发生率为 14%（95%CI 8-20%），早产发生率为 27%（95%CI 19-37%），低出生体重儿发生率为 22%（95%CI 15-30%）。与 NCPH 相比，CPH 组产后出血风险更高（RR 5.09，95%CI 1.84-14.12），静脉曲张出血风险更低（RR 0.51，95%CI 0.30-0.86）。NCPF 和 EHPVO 之间各种结局的风险无差异。
每 10 例妊娠中就有 1 例并发门静脉高压症，血小板减少是最常见的并发症。肝功能失代偿和静脉曲张出血仍然是母亲死亡的最常见原因，但随着怀孕期间内镜治疗的引入，出血及其并发症的发生率有所降低。CPH 增加了产后出血的风险，而 NCPH 中静脉曲张出血的风险更高。
