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Portal hypertension and pregnancy Volume 25, issue 5, Mai 2018

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Authors
1 APHP, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Site Jean Verdier, Pôle d’Activités Cancérologiques Spécialisées, Service d’Hépatologie, F-93143 Bondy, France
2 Université Paris 13, Sorbonne Paris Cité, UFR SMBH, F-93000 Bobigny, France
3 Inserm, UMR-1162, Génomique fonctionnelle des Tumeurs solides, IUH, Paris, F-75010, France
4 APHP, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Site Jean Verdier, Service de Gynécologie obstétrique, F-93143 Bondy, France
* Tirés à part

Pregnancy in patients with portal hypertension is considered as an at-risk pregnancy that required a multidisciplinary management including obstetricians, hepato-gastroenterologists, pediatricians and anesthesiologists. Portal hypertension is associated with an increased risk of miscarriage, stillbirth and preterm birth. Moreover, there is an increase of the portal pressure during pregnancy with a risk of variceal bleeding especially during the second trimester where the blood volume of the mother rises. In patients with portal hypertension, prenatal counseling is required with an adequate screening of portal hypertension before pregnancy. Prophylaxis of variceal bleeding is recommended in front of medium and large varices in order to improve the prognosis of the mother and the foetus. Upper endoscopy is required before pregnancy or at diagnosis of liver disease if the diagnosis is performed during pregnancy. Adequate prophylaxis of variceal bleeding should be performed by non-selective Beta-blockers or band ligation in front of medium or large varices. Occurrence of variceal bleeding is a severe complication that required a prompt introduction of vasoactive treatment, antibiotics and an upper endoscopy in order to perform band ligation. Vaginal delivery is not contra-indicated and not associated with an increased risk of variceal bleeding. Caesarean delivery is associated with hemorrhage and infectious complications. It should not be systematically performed and only restricted to obstetrical indications.

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