1. High-risk third trimester pregnancy with decompensated cirrhosis safely delivered following emergent preoperative interventional radiology for mitigation of variceal bleeding
- Author
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Linnan Tang, Claire Dorsey, Yuval A. Patel, Jennifer Gilner, Paul V. Suhocki, Christine Park, and Nikhil Kapila
- Subjects
Liver Cirrhosis ,medicine.medical_specialty ,Cirrhosis ,medicine.medical_treatment ,Pregnancy Trimester, Third ,Radiology, Interventional ,Esophageal and Gastric Varices ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,medicine ,Risk of mortality ,Coagulopathy ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,medicine.disease ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Portal hypertension ,Female ,Portasystemic Shunt, Transjugular Intrahepatic ,business ,Gastrointestinal Hemorrhage ,Transjugular intrahepatic portosystemic shunt - Abstract
Coagulopathy coupled with severe portal hypertension in the setting of cirrhosis increases the risk of mortality from variceal bleeding in pregnant women. Studies suggest transjugular intrahepatic portosystemic shunt (TIPS) creation to be a safe procedure during pregnancy in preventing variceal bleeding complications; however, it is not typically employed in severely decompensated cirrhosis. This case report of a pregnant woman presenting at 34.7 weeks' gestation demonstrates successful variceal mapping, emergent TIPS creation and variceal embolization to allow safe cesarean delivery despite severe hypofibrinogenemia and decompensated alcoholic cirrhosis. With careful medical optimization, angiographic imaging and vascular interventional radiology may be employed outside of usual indications to achieve safe pregnancy delivery and postpartum recovery.
- Published
- 2020