Historical perspective of cirrhosis and pregnancy Sample Clauses

Historical perspective of cirrhosis and pregnancy. Pregnancy in cirrhotic women is rare. This relates to a combination of metabolic, endocrine, nutritional and sexual dysfunction as outlined above. (94-98) Historically, women with cirrhosis have therefore been considered infertile, although occasional successful pregnancies have been reported. (102) Additionally, due to the undefined risks, women with cirrhosis were routinely advised against pregnancy by their physicians. The first case in the published literature describing pregnancy in a women with underlying cirrhosis was reported in 1954. (103) Between this initial report and 1968 a total of 64 pregnancies were reported in 47 women. (104) A significant deterioration of liver function or gastrointestinal bleeding occurred in 32 out of the 47 women (68%). In 1968, Xxxxxxx and Xxxxxxxx reported on the clinical course and outcome in 16 pregnancies in 13 women all with biopsy proven cirrhosis either secondary to “chronic active hepatitis” or primary biliary cirrhosis. (102) Foetal outcomes included 5 abortions (4 spontaneous), 3 still births, 1 neonatal death and 7 live births. Maternal outcomes included 1 death from hepatic failure at 30 weeks gestation, 1 episode of severe variceal bleeding at 5 months gestation requiring portocaval anastomosis and one episode of decompensation with the development of ascites. (102) More than 25-years later, a further case series reporting on the outcomes of pregnancy in 11 women with cirrhosis between 1974 and 1992 was published. (105) In this series the foetal mortality was 8%, with 6 small for dates neonates and 3 premature births. Maternal complications were common with 6/11 (55%) experiencing a variceal bleed during pregnancy, 3 (27%) developing ascites and 3 (27%) developing a significant infectious puerperal complication. (105) Although this historic information is useful, and undeniably tells us that pregnancy in women with cirrhosis carries a significant risk both for the mother and baby, its utility in the present day to provide preconception counselling to women with cirrhosis enquiring about pregnancy is limited. With current advances in neonatal intensive care and the routine administration of corticosteroids for foetal lung maturity in premature births, infant mortality rates are therefore likely to be lower than the above reported series. Moreover, maternal outcomes are likely to have improved with the advent of endoscopic techniques and a better understanding and treatment of the complications of cirrhosis...
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