[Pregnancy and lever cirrhosis: a high-risk combination]

Pregnancy rarely occurs in women with liver cirrhosis. However, for those who do become pregnant there are substantial maternal and foetal risks.

A 29-year-old pregnant woman with fully compensated liver cirrhosis was referred to a tertiary centre. No oesophageal or stomach varices were identified, nor indications for decompensation of the liver disease. Following an uneventful pregnancy, she gave (vaginal) birth at term to a healthy son.

The risk of complications in pregnant patients with liver cirrhosis is related to the degree of liver dysfunction and the presence of portal hypertension, emphasizing the importance of individualised preconception counselling. Oesophageal or stomach variceal bleeding during pregnancy carries a considerable risk of mortality. Therefore, screening endoscopy in the second trimester is advised to facilitate primary prophylaxis of variceal bleeding. Although the risk of variceal bleeding is increased during delivery, elective caesarean sections are not routinely performed because of an increased risk of bleeding due to abdominal wall varices. Pregnant women with liver cirrhosis should ideally be managed in a tertiary centre and in a multidisciplinary setting, to include input from a gynaecologist and gastroenterologist/hepatologist.