Publication:

A case of extra hepatic portal vein obstruction in pregnancy with superimposed pre-eclampsia

Extra hepatic portal vein obstruction in pregnancy poses a clinical challenge by itself. We present here a case of a 19 year old primigravida with EHPVO who developed superimposed preeclampsia. She had a successful maternal and fetal outcome in a tertiary care centre owing to the team effort involving specialists from medical gastroenterology, nephrology, anesthesiology, and neonatology apart from senior obstetrician. EHPVO is an important cause of non-cirrhotic portal hypertension in third world countries. In pregnancy, the increased blood volume and cardiac output and mesenteric vasodilatation will increase portal flow and aggravate portal hypertension in these patients. The resultant hematemesis in such patients, can compromise the perinatal outcome. Endoscopic variceal ligation (EVL) reduces the risk of variceal bleeding, and can improve the pregnancy outcome in these women. Thrombocytopenia due to splenomegaly is one of the major complications in these patients and has to be corrected before pregnancy. Platelet transfusion is required intrapartum if the count is less than 50,000/mm3 caesarean delivery is reserved only for obstetric indications.