Outcome of pregnancy in patients with liver cirrhosis

ABSTRACT

To evaluate the maternal and foetal outcomes in patients with liver cirrhosis and to determine the impact of pregnancy on the hepatic disease process. A prospective observational study. Setting: Sohag University hospital. Fifty one pregnant women with liver cirrhosis. They were followed throughout pregnancy to detect signs of hepatic decompensation and to detect any obstetric complication. Foetal growth curve was done bimonthly or monthly. 18% of patients developed hepatic decompensation during pregnancy; of whom 88% have occurred during the last 4 weeks of pregnancy. Only 2% of this decompensation has occurred before 32 weeks of gestation. 60% of patients developed obstetric complications. Preterm labour, HELLP syndrome, pre-eclpmsia and non-traumatic postpartum haemorrhage increase in patients with liver cirrhosis. The vast majority of these complications have occurred in patients delivered beyond 36 weeks of pregnancy. 30% of fetuses showed IUGR and 15% died intrauterine mainly in patients who developed hepatic decompensation. The maternal mortality was 8% and all were the result of hepatic coma occurring during labour. The risk of hepatic decompensation increases during the last 4 weeks of pregnancy. Preterm labour, HELLP, PET and PPH increases in decompensated patients. Hepatic coma during labour is the leading cause of maternal death. Termination of pregnancy at 36 weeks of pregnancy can decrease the maternal morbidity and mortality