Pregnancy Outcome Among Cirrhotic Patients

Backgrounds:Pregnancy is not uncommon in cirrhotic patients with current advances in assisted reproduction techniques. Such pregnancy is likely to increase in the coming years and causes the medical challenges for both patients and clinicians.Material and method :This article was written by reviewed the available original and review literature which has been published in English in websites of Google scholar and Pub Med with keywords cirrhosis, pregnancy outcome, portal hypertension, and hepatic decompensation since 2010.Result: Maternal mortality and the poor fetal outcome are serious complications. Poor pregnancy outcome is related to a model for end-stage liver disease (MELD) score more than 10. Pregnancy outcome can be improved if the physicians follow extensive counseling before or at the beginning of the pregnancy. The hepatologist has the main role in predicting maternal risks. 30% - 64% of cirrhotic patients will suffer from liver-related complications during or after pregnancy. The patients with a high MELD score are at risk for a poor maternal outcome, increased rate of disease decompensation and 7.8 % mortality. Elective termination of pregnancy on medical grounds and postponing pregnancy after liver transplantation should be considered in this group. But cirrhotic patients with a MELD score of 6 or less have minimum complications. Liver failure, ascites, hepatic encephalopathy, and variceal bleeding are serious complications that may occur during pregnancy. The upper endoscopy must be done both before pregnancy and in the second trimester to assess for the development of varices. Postpartum hemorrhage and delivery complications may occur at the termination period. The successful management of a cirrhotic patient needs a multidisciplinary team. This team discusses the case before pregnancy and follows her during gestation and delivery in a tertiary care center. The aim of this article was to review the approach and outcome of pregnancy among cirrhotic patients in recent years.Conclusion: The approach and treatment protocols seemed to be relatively diverse and highly dependent upon the conditions of cirrhotic patient. Majority of the recent experiences showed that pregnancy outcome was better than old reports in cirrhotic patients