What is portal hypertension during pregnancy?
Portal hypertension is high blood pressure (hypertension) in the hepatic portal system, a system of veins that carries blood to the liver from various sections of the gastrointestinal tract, the spleen, pancreas, and gallbladder. The pressure in this system increases due to liver cirrhosis, the main causes of which are alcoholism, hepatitis B virus (HBV), and hepatitis C virus (HCV). Liver disease with cirrhosis is rare during pregnancy, but HBV is fairly common in certain parts of the world. Additionally, non-cirrhotic portal hypertension (NCPH) also can occur. This can happen due to various, recognized causes, such as infections, autoimmune diseases (such as SLE [lupus]), and toxins affecting the liver and processes upstream and downstream from the liver. If no cause can be diagnosed, the condition is called idiopathic non-cirrhotic portal hypertension (INCPH).
How common is portal hypertension during pregnancy?
As noted above, portal hypertension can result from liver damage due to infection with HBV. In the United States, the maternal prevalence of HBV (the fraction of women testing positive for HBV infection) has been reported as 9 per 1,000 pregnant women, but the numbers vary between different segments of the US population. HBV infection has been reported in pregnant women at much higher rates in other parts of the world, in some cases, even approaching 10 percent or more. In HBV endemic regions, the most important route by which HBV spreads is mother-to-child transmission. However, 15 percent of people suffering from idiopathic INCPH are females of reproductive age.
How is portal hypertension during pregnancy diagnosed?
Portal hypertension produces particular signs that are noticeable on physical examination. These include ascites (a fluid-filled, distended abdomen), and enlarged, swollen veins (varices) that can be observed on the abdomen or in the anus. Various blood tests and ultrasonography will also be performed. Because portal hypertension carries a high risk of bleeding from the esophagus, you also need to be evaluated with a procedure called an upper endoscopy.
Does portal hypertension cause problems during pregnancy?
Portal hypertension causes blood to detour through certain groups of veins that normally carry less blood. This causes the development of varices, which are swollen veins. In certain locations, such as the esophagus, varices are prone to severe, life-threatening bleeding. Other dangerous complications of portal hypertension include ascites, esophageal varices, deterioration of brain function (hepatic encephalopathy), and kidney failure resulting from liver damage (hepatorenal syndrome).
Does portal hypertension cause problems for the baby?
Portal hypertension elevates the risk for spontaneous abortion (miscarriage), stillbirth, and preterm and premature mature birth. These outcomes are particularly likely if you suffer from variceal bleeding.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the portal hypertension
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat portal hypertension during pregnancy?
Your doctors may decide to lower your risk of variceal bleeding by lowering your blood pressure with beta-blocker medication, and possibly a diuretic (a drug that promotes excretion of water through the kidney). Beta-blocker treatment carries a risk of fetal growth restriction and slowing down the fetal heartbeat. However, the fetal risks must be weighed against the risk of the mother suffering a life-threatening bleed. Particularly if you suffer from ascites (swollen abdomen), a diuretic will be a likely part of the treatment, and your doctors are likely to put you on an antibiotic regimen (usually a 3rd generation cephalosporin) because ascites carries a risk of spontaneous bacterial peritonitis. Another medication given for lowering portal pressure is isosorbide, but more study is required of this drug in pregnancy settings.
Who should NOT stop taking medication for portal hypertension during pregnancy?
The decision regarding blood pressure medications is a trade-off that must balance the fetal risks with an evaluation of your risk of bleeding from varices. If you are started on an antibiotic, you must complete the treatment regimen, or the doctor can switch you to a different antibiotic.
What should I know about choosing a medication for my portal hypertension during pregnancy?
It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.
You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.
What should I know about taking a medication for my portal hypertension when I am breastfeeding?
If you are not already on an antibiotic at the time of delivery, you will be put on an antibiotic, because of a high risk of post-partum infection, including spontaneous bacterial peritonitis. Generally, the antibiotic given will be one that is considered safe in nursing mothers.
What alternative therapies besides medications can I use to treat my portal hypertension during pregnancy?
Common treatments for portal hypertension include sclerotherapy and banding, both of which are performed by way of endoscopy for the purpose of preventing varices from bleeding. Surgical treatments are available to shunt blood away from the portal system in order to lower the pressure. A large component of the management consists of supportive measures, such as the administration of fluids and monitoring of your liver function. If you are progressing toward liver failure, it may become necessary to terminate the pregnancy in order to save your life. In the case of liver failure, the only curative treatment is liver transplantation.
What can I do for myself and my baby when I have portal hypertension during pregnancy?
Follow the instructions of your physicians. Report any side effects that you experience from your medications.
Resources for portal hypertension in pregnancy:
For more information about portal hypertension during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations: