Elsevier

Journal of Hepatology

Volume 57, Issue 6, December 2012, Pages 1214-1219
Journal of Hepatology

Research Article
Pregnancy in women with portal vein thrombosis: Results of a multicentric European study on maternal and fetal management and outcome

https://doi.org/10.1016/j.jhep.2012.07.034Get rights and content

Background & Aims

Women of childbearing age account for approximately 25% of patients with non-cirrhotic portal vein thrombosis (PVT). We aimed at assessing maternal and fetal outcome in pregnant women with known PVT.

Methods

We performed a retrospective analysis of the files of women with chronic PVT in three European referral centers between 1986 and 2010.

Results

Forty-five pregnancies, 28 (62%) treated with low molecular weight heparin, occurred in 24 women. Nine (20%) were lost before gestation week 20. Preterm birth occurred in 38% of deliveries: there were 3 births at week 24–25, 7 at week 32–36, and 26 after week 37. A term birth with a healthy infant occurred in 58% of pregnancies. Cesarean section was used in 53% of deliveries. Two women developed HELLP syndrome. A favorable outcome happened in 64% of pregnancies. Pregnancies with an unfavorable outcome were associated with a higher platelet count at diagnosis. Bleeding from esophageal varices occurred in 3 patients during pregnancy, all without adequate primary prophylaxis. Genital or parietal bleeding occurred postpartum in 4 patients, only one being on anticoagulation therapy. Thrombotic events occurred in 2 patients, none related to lower limbs or mesenteric veins. There were no maternal deaths.

Conclusions

In pregnant PVT patients treated with anticoagulation on an individual basis, the rate of miscarriage and preterm birth appears to be increased. However, fetal and maternal outcomes are favorable for most pregnancies reaching gestation week 20. High platelet counts appear to increase the risk for unfavorable outcome. Pregnancy should not be contraindicated in stable PVT patients.

Introduction

Portal vein thrombosis (PVT), in the absence of cirrhosis or hepatobiliary tumors, is a rare disorder characterized by the development of a thrombus in the portal vein or its left or right branches, often leading to portal hypertension [1]. Extension to mesenteric venous arches carries a high risk of intestinal infarction, with a reported mortality rate up to 50% [2]. In the absence of recanalization, a network of collateral veins, the so called portal cavernoma, develops. Portal cavernoma is associated with a permanent risk of potentially fatal gastrointestinal bleeding due to portal hypertension. Recurrent thrombosis may also occur, as numerous non-correctable risk factors for venous thromboembolism, including several prothrombotic conditions, have been implicated in PVT [3].

The outcome of chronic PVT has improved over the past years, in parallel with intensified prophylaxis for bleeding related to portal hypertension, and control of underlying prothrombotic conditions [4], [5], [6]. As a result, desire for pregnancy has become a major issue for young women with well-controlled chronic PVT. However, from the limited number of available reports [7], [8], [9], [10], [11], [12], [13], it is unclear whether pregnancy is hazardous and should be contraindicated in patients with PVT [14], and whether concurrent anticoagulation therapy should be continued.

The current study aimed at assessing manifestations, associated prothrombotic risk factors, and the fetal and maternal outcome in women with known and stable PVT becoming pregnant during follow-up. In particular, we aimed at assessing the risk of bleeding from portal hypertension, the risk of thrombosis during and after pregnancy in patients treated with anticoagulation on an individual basis, and the risk of a poor outcome for fetuses and infants.

Section snippets

Study group

The files of female patients younger than 45 years, diagnosed with PVT at one of three referral centers (Hôpital Beaujon, Clichy, France; Erasmus University Medical Center, Rotterdam, The Netherlands; Hospital Clinic, Barcelona, Spain) were retrospectively analyzed. Date of diagnosis of PVT was considered as the date of the first imaging procedure demonstrating thrombosis of the portal vein. Patients with cirrhosis, hepatobiliary malignancy, liver transplantation or concomitant Budd-Chiari

Results

Twenty-four women had 45 pregnancies during the follow-up after PVT diagnosis: 12 women with one pregnancy, six with two pregnancies, four with three pregnancies, one with four pregnancies, one with five pregnancies. Their characteristics before pregnancy are presented in Table 1. Main underlying causes of PVT identified prior to pregnancy and in the absence of liver insufficiency were myeloproliferative neoplasm, protein S deficiency and antiphospholipid syndrome. The myeloproliferative

Discussion

Women of childbearing age account for around 25% of patients with non-cirrhotic PVT [19]. Pregnancy has long been thought to be contraindicated in these patients as little was known on the risks of recurrent thrombosis and bleeding, particularly when anticoagulation is administered [7], [8], [9], [10], [11], [12]. Indeed, underlying prothrombotic conditions are common in PVT patients [6], [20], which is reflected by the results of this study. A myeloproliferative neoplasm was present in 18% of

Conflict of interest

The authors declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.

Acknowledgments

We thank Alice Marot and Kamal Zekrini, Dr. Boadas and Dr. Mereish and Dr. Grifoll for their help including patients and Dr. Noëlle Bendersky for her help in identifying patients.

References (31)

  • B. Condat et al.

    Nonmalignant portal vein thrombosis in adults

    Nat Clin Pract Gastroenterol Hepatol

    (2006)
  • A. Plessier et al.

    Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study

    Hepatology

    (2009)
  • E.E. Buyukbayrak et al.

    Successful pregnancy in a patient with portal hypertension secondary to portal vein thrombosis due to essential thrombocythaemia: a rare case

    J Matern Fetal Neonatal Med

    (2010)
  • J.B. Cardozo et al.

    Portal phlebothrombosis in the puerperium

    Br Med J

    (1963)
  • J.C. Chambers et al.

    Methylenetetrahydrofolate reductase 677 C  T mutation and coronary heart disease risk in UK Indian Asians

    Arterioscler Thromb Vasc Biol

    (2000)
  • Cited by (0)

    View full text