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Perinatal Management of Esophageal Varices
Elisabeth N Adkins1, Carla W Brady2, Jeffrey A Kuller3
1OB/GYN Resident, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN.
Obstetrical & Gynecological Survey
|January 20, 2026
Summary
Managing esophageal varices in pregnancy requires individualized care. This includes preconception counseling, surveillance, and tailored delivery plans to prevent variceal bleeding.
Area of Science:
- Gastroenterology and Hepatology
- Obstetrics and Gynecology
Background:
- Pregnancy presents unique physiological challenges for patients with cirrhosis and portal hypertension.
- There is an increased risk of esophageal varices worsening and life-threatening variceal hemorrhage during pregnancy, especially in the third trimester and intrapartum.
Purpose of the Study:
- To review preconception counseling, antepartum surveillance, and intrapartum management strategies for pregnant patients with esophageal varices.
- To emphasize current professional societal guidelines for optimizing care.
Main Methods:
- A comprehensive literature review was conducted.
- Relevant research, review articles, databases, and societal guidelines were identified and analyzed.
Main Results:
- Optimal management necessitates an individualized, multidisciplinary approach.
- Preconception screening endoscopy is recommended; a second-trimester endoscopy may be considered during pregnancy.
- Management strategies vary based on varix size, including beta-blockers for small varices and therapeutic endoscopy for medium to large varices.
- Delivery mode (vaginal or Cesarean) is individualized based on bleeding risk and patient needs.
- Postpartum care includes Hepatology follow-up and contraception counseling.
Conclusions:
- Individualized care is paramount for managing esophageal varices in pregnant patients with cirrhosis and portal hypertension.
- Increasing rates of cirrhosis in reproductive-aged women necessitate enhanced clinical awareness and management strategies.
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