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Grand Rounds

Pregnancy Outcomes in Women with Budd-Chiari Syndrome

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BACKGROUND AND PURPOSE: 

  • Budd-Chiari syndrome (obstruction of the hepatic venous outflow caused by thrombosis of the hepatic veins or proximal IVC) and portal vein thrombosis are unusual manifestations of venous thromboembolism 
  • Wiegers et al. (BJOG, 2021) evaluated current practice and outcomes of pregnancy in women with Budd-Chiari syndrome and/or portal vein thrombosis 

METHODS: 

  • Multicenter retrospective cohort study  
  • Population 
    • Women who conceived in the study period after a diagnosis of Budd-Chiari syndrome and/or portal vein thrombosis 
  • Primary outcomes 
    • Maternal mortality 
    • Live birth rate 
  • Secondary outcomes 
    • Maternal, neonatal, and obstetric complications 

RESULTS: 

  • 45 women | 76 pregnancies 
    • Budd-Chiari syndrome: 12 women 
    • Portal vein thrombosis: 33 women 
  • Presence of underlying prothrombotic disorders: 51% 
  • Received low-molecular-weight heparin during pregnancy: 84% 
  • Neonatal outcomes of 45 first pregnancies 
    • Pregnancy loss: 24% 
    • Live birth: 76% | 79% of live births were at term  
  • Maternal outcomes  
    • There were no maternal deaths 
    • Pulmonary embolism during pregnancy: 1 woman 
    • Variceal bleeding requiring intervention: 4% (2 women) 

CONCLUSION: 

  • Women with a previous diagnosis of Budd-Chiari syndrome experienced a high percentage of live births at term  
    • There were also fewer than expected major maternal or neonatal morbidities  
  • However, a multidisciplinary approach with individualized care is still required to optimize outcomes  
  • The authors conclude 

The high number of term live births and lower than expected rate of pregnancy-related maternal and foetal morbidity in our small cohort indicate that there is no absolute contra-indication for pregnancy in patients with Budd-Chiari syndrome and/or portal vein thrombosis 

Learn More – Primary Sources: 

Pregnancy outcomes in women with Budd-Chiari syndrome or portal vein thrombosis A multicentre retrospective cohort study 

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Related ObG Topics:

Which Thrombophilias in Pregnancy Warrant Thromboprophylaxis? 
What are the Risks of VTE After Peripartum Hysterectomy?
What is the Risk for Recurrent VTE after Stopping Anticoagulation Treatment?

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