Portal hypertension in pregnancy - Concealed perils

A Rare Case of Portal Hypertension and Ascites Following Intrauterine Fetal Death: A Case Report

We present a rare case of a 25-year-old woman who developed idiopathic portal hypertension and ascites four days after delivering a stillborn child at term. She had no previous liver illness or risk factors for portal vein thrombosis. Investigations revealed a dilated portal vein, esophageal varices, and high serum-albumin gradient ascites, all of which point to a presinusoidal etiology of portal hypertension. There was no indication of cirrhosis, hepatic or portal vein thrombosis, metabolic or autoimmune liver diseases, or persistent infections. She was treated with antibiotics, diuretics, and beta-blockers, and she underwent a therapeutic paracentesis. The etiology of her portal hypertension remains undetermined. Idiopathic portal hypertension is a rare condition of unknown etiology, characterized by portal hypertension without cirrhosis or thrombosis. It is linked to several risk factors and histological abnormalities, and it can be accompanied by portal hypertension consequences, such as variceal hemorrhage and ascites. The diagnosis is made using clinical criteria and the elimination of alternative causes of portal hypertension. Management is mostly symptomatic, intending to avoid and treat portal hypertension consequences. The prognosis varies according to the underlying etiology and presence of complications.

Splenic artery aneurysm in pregnancy: A systematic review

OBJECTIVE

Splenic artery aneurysms (SAA) are associated with significant maternal and fetal mortality when ruptured in pregnancy. However, there is no consensus on the optimal obstetric management of both ruptured and asymptomatic SAA. We aimed to evaluate risk factors, presentation, investigation, and management of SAA in pregnancy and puerperium.

METHODS

MEDLINE, EMBASE, and Scopus were screened from January 2000 to October 2020 using keywords related to pregnancy and SAA. Articles on ruptured and unruptured SAA in pregnancy until 6 weeks postpartum were considered. Data were extracted by two independent reviewers. Quantitative analysis and narrative synthesis were used.

RESULTS

Seventy-five ruptured and nine unruptured SAA cases were included. Mean age was 31.1 ± 5.2 years, of which 47 (64.4%) were multiparous and 46 (54.8%) presented in their third trimester, largely with epigastric and left-sided abdominal pain. The double-rupture phenomenon of delayed blood loss and symptoms was noted in 11 (14.7%); 60 (70.7%) underwent preoperative imaging. Mean SAA size was 23.0 ± 13.6 mm. Ruptured SAA were primarily managed by laparotomy (61, 81.3%) typically with splenectomy,  and unruptured SAA by embolization or laparotomy. There was no mortality in unruptured SAA, but significant mortality on rupture (19, 25.7% maternal; 36, 50.0% fetal).

CONCLUSION

Given their predisposition and high mortality in pregnancy, it is crucial that SAAs are promptly diagnosed and managed, requiring increased obstetrician awareness.