Pregnancy outcomes in women with Budd-Chiari syndrome or portal vein thrombosis - a multicentre retrospective cohort study

Objective

To evaluate current practice and outcomes of pregnancy in women previously diagnosed with Budd–Chiari syndrome and/or portal vein thrombosis, with and without concomitant portal hypertension.

Design and setting

Multicentre retrospective cohort study between 2008 and 2021.

Population

Women who conceived in the predefined period after the diagnosis of Budd–Chiari syndrome and/or portal vein thrombosis.

Methods and main outcome measures

We collected data on diagnosis and clinical features. The primary outcomes were maternal mortality and live birth rate. Secondary outcomes included maternal, neonatal and obstetric complications.

Results

Forty‐five women (12 Budd–Chiari syndrome, 33 portal vein thrombosis; 76 pregnancies) were included. Underlying prothrombotic disorders were present in 23 of the 45 women (51%). Thirty‐eight women (84%) received low‐molecular‐weight heparin during pregnancy. Of 45 first pregnancies, 11 (24%) ended in pregnancy loss and 34 (76%) resulted in live birth of which 27 were at term (79% of live births and 60% of pregnancies). No maternal deaths were observed; one woman developed pulmonary embolism during pregnancy and two women (4%) had variceal bleeding requiring intervention.

Conclusions

The high number of term live births (79%) and lower than expected risk of pregnancy‐related maternal and neonatal morbidity in our cohort suggest that Budd–Chiari syndrome and/or portal vein thrombosis should not be considered as an absolute contraindication for pregnancy. Individualised, nuanced counselling and a multidisciplinary pregnancy surveillance approach are essential in this patient population.

Tweetable abstract

Budd–Chiari syndrome and/or portal vein thrombosis should not be considered as an absolute contraindication for pregnancy.

Budd–Chiari syndrome and/or portal vein thrombosis should not be considered as an absolute contraindication for pregnancy.

Linked article This article is commented on by YY Chung & MA Heneghan pp. 618 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17002.

Benefits and challenges of going abroad for research or clinical training

Research or clinical experience abroad is often encouraged for early career professionals to enhance their future career prospects. If resources are available to facilitate this, we believe that a fellowship abroad should definitely be considered. It can be a great asset, but also an exciting and scary experience at the same time. We, Nicoletta and Mandy, medical doctors in Italy and the Netherlands, respectively, have been fortunate enough to gain abroad experience: Nicoletta in Birmingham, United Kingdom, for 12 months, doing a clinical research fellowship in the field of anticoagulation and atrial fibrillation, working with Prof. Gregory Lip, and Mandy in Hamilton, ON, Canada, for 13 months, undertaking a clinical research fellowship in the field of anticoagulation, stroke and atrial fibrillation, with Dr John Eikelboom, Prof. Jack Hirsh, Prof. Jeff Weitz and, Prof. Stuart Connolly. As we have both experienced the benefits but also the challenges resulting from these encounters, we hope that this forum piece will provide other early career professionals with helpful suggestions and, above all, fill them with excitement about an international training opportunity.

Early career professionals: the mission of a task force

Early career researchers and clinicians face unique challenges in comparison with more senior colleagues, for instance connecting with expert leaders outside of their own institution to enhance their expertise. As the largest international thrombosis and hemostasis professional society, the ISTH can play a central role in supporting the development of early career professionals. The ISTH Early Career Task Force was formed to improve support for, and encourage collaboration between early career thrombosis and hemostasis researchers and clinicians. These activities include (1) maintaining an online forum for early career ISTH members to connect, promote clinical, research, funding and educational activities, and to generate a sense of community; (2) broaden ISTH's reach with early career professionals in the developing world through promotion of the Reach-the-World fellowships and translating ISTH websites into six languages; (3) encourage early career engagement with ISTH activities, such as guidelines and guidance document processing and online webinar series; and (4) establishing this early career forum series in this journal. The JTH Forum series will highlight the early career perspective on a wide range of issues relevant to this group, and all ISTH early career members are encouraged to contribute.

The success of a weekly medical quiz. Test-based medical education

BACKGROUND

Clinical images and tests are considered useful tools to enhance the memorisation of facts and information in medical education. Therefore, we initiated a weekly medical quiz for our department of Internal Medicine.

METHODS

Every week, a new case on a single slide with relevant information and a representative image, is sent by e-mail to staff, residents and others. All are requested ona voluntary basis to e-mail the presumed diagnosis within one week.

RESULTS

After two years, 100 cases were presented to 452 registered participants. On average, only 33 of 452 (range 14 to 59) participants (7.3%; 95% CI 4.9 to 9.7) responded per case. Most presumed diagnoses were submitted on the same day the case was sent (OR 0.81; 95% CI 0.69 to 0.94; p<0.01). Cases with a high response rate were associated with relatively more correct answers than cases with a low response rate. In addition, it was striking that participants in some subspecialities, particularly specialists in infectious diseases, were much more likely to respond to cases in their own subspecialty.

CONCLUSION

Our experience with a weekly medical quiz demonstrates rather low response rates. This could be due to time restraints, but could also be due to the fact that doctors do not like to be wrong, and are afraid to fail among their peers. Hence, although images and tests may be helpful learning tools, the success and contribution of such clinical-based quizzes to medical education are difficult to determine.