Pregnancy in patients with non-cirrhotic portal hypertension: a systematic review of the literature

Abstract

Non-cirrhotic portal hypertension (NCPH) includes a heterogeneous group of conditions. The aim of this study was to understand pregnancy in patients with non-cirrhotic portal hypertension. This is a scope review study, which is used to map evidence on a given phenomenon and identify existing gaps. Data collection was carried out between June and August 2022. The investigations were carried out in the US National Library of Medicine, National Institutes of Health (PubMed), Latin American and Caribbean Literature in Health Sciences (Lilacs), SciVerse, and Scopus (Scopus), Web of Science. The acronym 'PCC' was used, with P for population (pregnancy), C for concept (Patients) and C for context (non-cirrhotic portal hypertension). We identified 19 studies that reported at least one outcome of interest for the review. Bleeding from varices is one of the most common clinical manifestations in HPNC. Prenatal care with correction of high-risk varicose veins has satisfactory results during pregnancy. Cesarean section should be reserved for obstetric indications only. Pregnancy can be allowed and successfully managed in patients with HPNC. Prophylaxis for variceal bleeding can be done through endoscopic variceal ligation (EVL) or β-blockers. A previous history of variceal bleeding is a risk factor for bleeding during subsequent pregnancies6. Thus, combination therapy with EVL and β-blocker is preferred for patients with varices and a previous history of variceal bleeding. Thus, there is a scarcity of data in the literature on the occurrence of pregnancy and its outcome in patients with non-cirrhotic portal hypertension. Despite a significant incidence of complications related to portal hypertension, overall pregnancy outcomes have remained favorable in women with non-cirrhotic idiopathic portal hypertension. About 15% of patients with [non-cirrhotic idiopathic portal hypertension (INCPH)] are women of childbearing age who may become pregnant. However, pregnancy and the postpartum period are prothrombotic states and pregnancy can exacerbate portal hypertension.