Pregnancy in patients with chronic liver disease

The pregnant patient with established chronic liver disease presents a unique situation in medicine. Although neither the pregnancy nor the liver disease is likely to specifically worsen the other, the combination can result in fatal complications for mother and infant. Fertility is decreased in patients with advanced liver disease and may provide a degree of protection for many patients who would be at increased risk should they become pregnant; however, pregnancy may occur even with advanced liver disease, and it is necessary to anticipate and plan for possible complications of the specific hepatic disease encountered. Counseling prior to pregnancy is the best policy, with consideration to transplantation prior to childbearing or to sterilization if it is more appropriate. Most problems associated with advanced liver disease are managed as in the nonpregnant patient; however, variceal bleeding may be a particularly difficult problem, and management here may necessitate portacaval shunt surgery.