Pregnancy and its outcome in patients with noncirrhotic portal hypertension

There is paucity of data in the literature on the occurrence of pregnancy a nd its outcome in patients with noncirrhotic portal hypertension. The prese nt study was undertaken to assess the fertility pattern, fetal loss, and co nsequences of variceal bleeding during pregnancy in these patients. Fifty-f ive women of child-bearing age with a diagnosis of noncirrhotic portal hype rtension (including 32 with noncirrhotic portal fibrosis and 23 with extrah epatic portal venous obstruction) and 44 age-matched controls were studied. A detailed history of obstetric events and bleeding episodes was recorded in all patients. Any complication of portal hypertension was managed accord ingly. Patients were classified into three groups for analysis: group 1-obs tetric events after the diagnosis of portal hypertension in patients; group II-obstetric events before the diagnosis of portal hypertension in patient s; and group III-obstetric events in controls. A total of 116 pregnancies t ook place in 44 patients. Of these, 36 occurred after and 80 before the dia gnosis of portal hypertension was made. In the 44 controls, 118 pregnancies took place. The mean fertility rates of groups I, II and III were 0.20 +/- 0.24, 0.18 +/- 0.21, and 0.22 +/- 0.12 pregnancies per year! respectively? which were not statistically different (P > 0.05). The numbers of fetal lo sses in groups I, II and III were 3/36 (8.3%), 6/80 (7.5%), and 12/118 (10. 17%) pregnancies, respectively. Menstrual irregularities were found in 7/55 (12.72%) patients and 6/44 (13.6%) controls (P > 0.05). Five episodes of v ariceal bleeding occurred in 36 pregnancies after the diagnosis of portal h ypertension (13.88%). All five were successfully managed with endoscopic sc lerotherapy. In conclusion, noncirrhotic portal hypertensive patients have normal fertility and outcome of pregnancy. Variceal bleeding episodes are n ot common and endoscopic sclerotherapy is safe and effective in pregnancy.