Problems during and after pregnancy of former biliary atresia patients treated successfully by the Kasai procedure

Background/Purpose: The aim of this study was to investigate the problems a nd the quality of life during and after pregnancy of the patients who had u ndergone Kasai operation and to find out a strategy for follow-up during th e period of their pregnancy. Methods: A questionnaire was sent to 134 institutions of the Japanese Bilia ry Atresia Society with the following questions: (1) Do you have any pregna ncy cases in patients who had undergone Kasai operation? (2) Did she have a ny menstrual problem? (3) Did she have any problem during pregnancy and del ivery? (4) Did she have any change in liver function tests after delivery? (5) Did she have any early and long-term problem after delivery? (6) Did th e baby have any problem? (7) Was there any special care or comment about th e pregnancy of the biliary atresia patients? The responses were analyzed. Results: Fourteen institutions reported 16 cases of pregnancy, 23 cases of delivery, and 2 cases of abortion. The causes of abortion in the 2 cases we re attributed to hemorrhagic shock after massive bleeding from esophageal v arices and serious atopic dermatitis, respectively. Other problems during p regnancy were abruption of placenta, fetal distress leading to caesarian se ction, and development of liver dysfunction leading liver transplantation. Problems after delivery included deterioration of liver function in 6 patie nts (37.5%), attacks of ascending cholangitis in 4 patients (25.0%), and se vere fatigue with liver dysfunction from nursing the baby leading to liver transplantation. Only 3 of 16 (18.8%) patients were free of any problems. N o abnormality was seen in the babies. Conclusions: Even if the patients with biliary atresia lead a good postoper ative course, unexpected complications can occur when they become pregnant. Close long-term follow-up is required for proper management of pregnancy i n biliary atresia patients. Copyright (C) 2001 by W.B. Saunders Company.