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Gynecological Procedures and Pregnancy in Women with Liver Cirrhosis

  • Uma Perni
  • Haider Mahdi
  • Tommaso Falcone
Chapter

Abstract

Vaginal bleeding is common in women with liver cirrhosis. Hysterectomy is frequently done in women with liver cirrhosis. However, the postoperative mortality and morbidity is high and is correlated with severity of liver disease and other factors. Nonsurgical conservative options such as hormonal therapy or endometrial ablation should be tried first in women with liver cirrhosis. If surgery is needed, minimally invasive approach should be always considered. Women with liver cirrhosis undergoing surgery need extensive work up and should be optimized during the perioperative period. Further, surgery should be performed by an experienced surgeon and in a tertiary center.

Although pregnancy in women with liver cirrhosis is uncommon, increased maternal and neonatal complications have been reported. Complications include variceal hemorrhage, hepatic decompensation, splenic artery aneurysm, spontaneous abortion, preterm birth, and maternal and perinatal death. More recent literature suggests decreased mortality and morbidity in these pregnancies compared to reports from prior decades, likely reflecting advances in the treatment of liver disease and improved maternal and neonatal care. Preconception evaluation is recommended to identify women at higher risk for hepatic decompensation and other morbidities in whom pregnancy may be contraindicated. Evaluation and treatment of esophageal varices and tailoring of medication regimens are also important aspects of preconception evaluation. Pregnancy in the setting of liver cirrhosis requires specialized multidisciplinary care with intensive maternal and fetal monitoring in order to optimize outcomes.

Keywords

Menstrual disorders Tumor marker- CA-125 Pre-conception evaluation Postpartum hemorrhage Perinatal mortality Pre-eclampsia 

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Section of Maternal-Fetal MedicineCleveland Clinic Lerner College of MedicineClevelandUSA
  2. 2.Section of Gynecologic OncologyCleveland Clinic Lerner College of MedicineClevelandUSA
  3. 3.Cleveland Clinic Lerner College of Medicine and Chair ObstetricsGynecology and Women’s Health InstituteClevelandUSA

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