Biswas Sagnik, Sheikh Sabreena, Vaishnav Manas, Elhence Anshuman, Farooqui Naba, Anand Abhinav, Gamanagatti Shivanand
Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 110 029, India.
Mayo Clinic, Rochester, MN, USA.
Indian J Gastroenterol. 2023 Feb;42(1):96-105. doi: 10.1007/s12664-022-01307-7. Epub 2023 Feb 4.
Budd-Chiari syndrome (BCS) is associated with infertility and adverse pregnancy outcomes in affected females. Scant literature is available on the effect of an endovascular intervention on fertility and the outcome of future pregnancies in these patients.
To assess the infertility rates, maternal and fetal outcomes of pregnancy and effect of endovascular intervention in women with BCS.
In this retrospective analysis, 121 female patients with BCS attending our liver clinic from 2017 to 2020 were included. Demographic details, intervention details, pregnancies - pre- and post-intervention - and fetal outcomes were noted.
BCS was diagnosed pre-conception in 58 women (group 1; median age: 22 years), during/after pregnancy, but before completion of family in 39 (group 2; median age: 27 years), and after completion of family in 24 (group 3; median age: 34 years). Median Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores were 7 and 12, respectively. The primary infertility rate was 19.8% (24/121). In group 1, 15 women with primary infertility underwent endovascular intervention with 5/15 (33%) women conceiving subsequently, resulting in four live births and seven abortions. In group 2, five women developed BCS during pregnancy and 11 postpartum; 11/39 had a history of one or more abortions. Overall, 8/34 (23.5%) who underwent endovascular intervention had 4/8 (50%) successful pregnancies. In group 3, no patient had any major complications during past pregnancies. The mode of delivery was vaginal in 88% of cases. No congenital anomaly/major bleeding episodes/decompensation/maternal mortality occurred.
Infertility is common in patients with BCS. Pregnancy is well-tolerated in those with compensated liver disease.
布加综合征（BCS）与患病女性的不孕及不良妊娠结局相关。关于血管内介入治疗对这些患者生育能力及未来妊娠结局的影响，相关文献较少。
评估BCS女性患者的不孕率、妊娠的母婴结局以及血管内介入治疗的效果。
在这项回顾性分析中，纳入了2017年至2020年在我们肝病门诊就诊的121例BCS女性患者。记录了人口统计学细节、介入治疗细节、介入治疗前后的妊娠情况以及胎儿结局。
58例女性（第1组；中位年龄：22岁）在孕前被诊断为BCS，39例（第2组；中位年龄：27岁）在孕期/产后但在完成生育前被诊断为BCS，24例（第3组；中位年龄：34岁）在完成生育后被诊断为BCS。Child-Turcotte-Pugh（CTP）评分和终末期肝病模型（MELD）评分的中位数分别为7分和12分。原发性不孕率为19.8%（24/121）。在第1组中，15例原发性不孕女性接受了血管内介入治疗，其中5/15（33%）的女性随后怀孕，产下4例活婴，发生7例流产。在第2组中，5例女性在孕期发生BCS，11例在产后发生；11/39有过一次或多次流产史。总体而言，接受血管内介入治疗的8/34（23.5%）患者中有4/8（50%）成功妊娠。在第3组中，既往妊娠期间无患者发生任何严重并发症。88%的病例分娩方式为阴道分娩。未发生先天性异常/严重出血事件/肝功能失代偿/孕产妇死亡情况。
不孕在BCS患者中很常见。肝功能代偿的患者对妊娠耐受性良好。
