Segmental biliary ectasia and congenital hepatic fibrosis in a patient with chromosomal abnormality

Multiple normal deliveries in a woman with severe portal hypertension due to congenital hepatic fibrosis: the importance of preserved hepatocellular function

We report a 26-year-old woman with congenital hepatic fibrosis (CHFib), adult polycystic kidney disease, type II diabetes mellitus, and von Willebrand disease, who despite persistent advice to the contrary because of severe portal hypertension, had 5 pregnancies delivering 6 healthy infants over 8 yr. During this time, she experienced several episodes of esophageal variceal bleeding and severe ascites with persistently normal liver and renal function. CHFib is one of the prototypes of portal hypertension with preserved hepatocellular function. Although pregnancy is ill-advised in most women with portal hypertension and particularly with severe manifestations, this report illustrates the importance of preserved hepatocellular function for the outcome of pregnancy in these patients.

Cirrhosis and portal hypertension in pregnancy

Cirrhosis and portal hypertension infrequently coincide with pregnancy but increase maternal and fetal morbidity and mortality when present. Chronic liver disease and portal hypertension are not contraindications to pregnancy but necessitate intensive monitoring throughout pregnancy. The complications of liver disease are numerous and pose additional risks. Management of complications arising during pregnancy is similar to management in the nonpregnant patient. Provision of optimal care for mother and fetus can require the skills of multiple specialties such as maternal fetal medicine, gastroenterology, nutrition, and surgery. This report provides guidelines for the management of cirrhosis and portal hypertension in pregnancy.