High-risk third trimester pregnancy with decompensated cirrhosis safely delivered following emergent preoperative interventional radiology for mitigation of variceal bleeding

Christine Park, Yuval A. Patel, Paul Suhocki, Claire Dorsey, Nikhil Kapila, Linnan Tang, Jennifer Gilner

Research output: Contribution to journalArticlepeer-review

Abstract

Coagulopathy coupled with severe portal hypertension in the setting of cirrhosis increases the risk of mortality from variceal bleeding in pregnant women. Studies suggest transjugular intrahepatic portosystemic shunt (TIPS) creation to be a safe procedure during pregnancy in preventing variceal bleeding complications; however, it is not typically employed in severely decompensated cirrhosis. This case report of a pregnant woman presenting at 34.7 weeks' gestation demonstrates successful variceal mapping, emergent TIPS creation and variceal embolization to allow safe cesarean delivery despite severe hypofibrinogenemia and decompensated alcoholic cirrhosis. With careful medical optimization, angiographic imaging and vascular interventional radiology may be employed outside of usual indications to achieve safe pregnancy delivery and postpartum recovery.

Original languageEnglish (US)
Pages (from-to)143-147
Number of pages5
JournalClinical Imaging
Volume68
DOIs
StatePublished - Dec 2020
Externally publishedYes

Keywords

  • Cesarean delivery
  • Coagulopathy
  • Decompensated cirrhosis
  • Ectopic varices
  • Pregnancy
  • Transjugular intrahepatic portosystemic shunt

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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