Abstract：
BACKGROUND: Portal hypertension is secondary to either cirrhotic or non-cirrhotic causes, and complicating pregnancy poses a challenge to the treating team. A systematic review was performed to determine maternal and perinatal outcomes in women with portal hypertension. Outcomes were compared among those with cirrhotic (CPH) with non-cirrhotic portal hypertension (NCPH) as well as non-cirrhotic portal fibrosis (NCPF) with extra-hepatic portal vein obstruction (EHPVO).
METHODS: Medline and EMBASE databases were searched for studies reporting outcomes among pregnant women with portal hypertension. Reference lists from relevant papers and reviews were hand-searched for appropriate citations. Data were extracted to describe maternal complications, obstetric and neonatal outcomes. A random-effects model was used to derive pooled estimates of various outcomes, and final estimates were reported as percentages with a 95% confidence interval (CI). Cumulative, sequential and sensitivity analysis was studied to assess the temporal trends of outcomes over the period.
RESULTS: Information on 895 pregnancies among 581 patients with portal hypertension was included from 26 studies. Portal hypertension was diagnosed during pregnancy in 10% (95% CI 4-24%). There were 22 maternal deaths (0%, 95% CI 0-1%), mostly following complications from variceal bleeding or hepatic decompensation. Variceal bleeding complicated in 14% (95% CI 9-20%), and endoscopic interventions were performed in 12% (95% CI 8-17%) during pregnancy. Decompensation of liver function occurred in 7% (95% CI 3-12%). Thrombocytopenia was the most common complication (41%, 95% CI 23-60%). Miscarriages occurred in 14% (95% CI 8-20%), preterm birth in 27% (95% CI 19-37%), and low birth weights in 22% (95% CI 15-30%). Risk of postpartum hemorrhage was higher (RR 5.09, 95% CI 1.84-14.12), and variceal bleeding was lower (RR 0.51, 95% CI 0.30-0.86) among those with CPH compared to NCPH. Risk of various outcomes was comparable between NCPF and EHPVO.
CONCLUSIONS: One in ten pregnancies complicated with portal hypertension is diagnosed during pregnancy, and thrombocytopenia is the most common complication. Hepatic decompensation and variceal bleeding remain the most common cause of maternal deaths, with reduced rates of bleeding and its complications reported following the introduction of endoscopic procedures during pregnancy. CPH increases the risk of postpartum hemorrhage, whereas variceal bleeding is higher among NCPH.
METHODS: Medline and EMBASE databases were searched for studies reporting outcomes among pregnant women with portal hypertension. Reference lists from relevant papers and reviews were hand-searched for appropriate citations. Data were extracted to describe maternal complications, obstetric and neonatal outcomes. A random-effects model was used to derive pooled estimates of various outcomes, and final estimates were reported as percentages with a 95% confidence interval (CI). Cumulative, sequential and sensitivity analysis was studied to assess the temporal trends of outcomes over the period.
RESULTS: Information on 895 pregnancies among 581 patients with portal hypertension was included from 26 studies. Portal hypertension was diagnosed during pregnancy in 10% (95% CI 4-24%). There were 22 maternal deaths (0%, 95% CI 0-1%), mostly following complications from variceal bleeding or hepatic decompensation. Variceal bleeding complicated in 14% (95% CI 9-20%), and endoscopic interventions were performed in 12% (95% CI 8-17%) during pregnancy. Decompensation of liver function occurred in 7% (95% CI 3-12%). Thrombocytopenia was the most common complication (41%, 95% CI 23-60%). Miscarriages occurred in 14% (95% CI 8-20%), preterm birth in 27% (95% CI 19-37%), and low birth weights in 22% (95% CI 15-30%). Risk of postpartum hemorrhage was higher (RR 5.09, 95% CI 1.84-14.12), and variceal bleeding was lower (RR 0.51, 95% CI 0.30-0.86) among those with CPH compared to NCPH. Risk of various outcomes was comparable between NCPF and EHPVO.
CONCLUSIONS: One in ten pregnancies complicated with portal hypertension is diagnosed during pregnancy, and thrombocytopenia is the most common complication. Hepatic decompensation and variceal bleeding remain the most common cause of maternal deaths, with reduced rates of bleeding and its complications reported following the introduction of endoscopic procedures during pregnancy. CPH increases the risk of postpartum hemorrhage, whereas variceal bleeding is higher among NCPH.
摘要：
背景：门静脉高压症继发于肝硬化或非肝硬化原因，妊娠并发症对治疗团队构成了挑战。进行了系统评价，以确定患有门静脉高压症的女性的孕产妇和围产期结局。比较肝硬化（CPH）与非肝硬化门脉高压（NCPH）以及非肝硬化门脉纤维化（NCPF）与肝外门静脉阻塞（EHPVO）的患者的预后。
方法：在Medline和EMBASE数据库中搜索报告妊娠合并门静脉高压的孕妇结局的研究。手工搜索相关论文和评论的参考文献列表，以获取适当的引用。提取数据来描述母体并发症，产科和新生儿结局。使用随机效应模型来得出各种结果的汇总估计，最终估计值以百分比报告,置信区间为95%(CI).累积,研究了序贯分析和敏感性分析,以评估该期间结局的时间趋势.
结果：从26项研究中纳入了581例门脉高压患者中895例妊娠的信息。在妊娠期间诊断出门脉高压的比例为10％（95％CI4-24％）。有22例孕产妇死亡（0％，95%CI0-1%)，主要是静脉曲张出血或肝功能失代偿的并发症。静脉曲张破裂出血并发14％（95％CI9-20％），在妊娠期间进行内镜干预的比例为12%(95%CI8-17%).肝功能失代偿发生在7%(95%CI3-12%)。血小板减少是最常见的并发症（41%，95%CI23-60%）。流产发生率为14%（95%CI8-20%），27％的早产（95％CI19-37％），22％的低出生体重（95％CI15-30％）。产后出血的风险更高(RR5.09,95%CI1.84-14.12),与NCPH相比，CPH患者的静脉曲张出血较低（RR0.51，95％CI0.30-0.86）。各种结果的风险在NCPF和EHPVO之间是相当的。
结论：十分之一的妊娠合并门静脉高压症在妊娠期被诊断，血小板减少是最常见的并发症。肝脏代偿失调和静脉曲张破裂出血仍然是孕产妇死亡的最常见原因。在怀孕期间引入内窥镜手术后，出血率及其并发症的发生率降低。CPH增加产后出血的风险，而NCPH中静脉曲张出血较高。
方法：在Medline和EMBASE数据库中搜索报告妊娠合并门静脉高压的孕妇结局的研究。手工搜索相关论文和评论的参考文献列表，以获取适当的引用。提取数据来描述母体并发症，产科和新生儿结局。使用随机效应模型来得出各种结果的汇总估计，最终估计值以百分比报告,置信区间为95%(CI).累积,研究了序贯分析和敏感性分析,以评估该期间结局的时间趋势.
结果：从26项研究中纳入了581例门脉高压患者中895例妊娠的信息。在妊娠期间诊断出门脉高压的比例为10％（95％CI4-24％）。有22例孕产妇死亡（0％，95%CI0-1%)，主要是静脉曲张出血或肝功能失代偿的并发症。静脉曲张破裂出血并发14％（95％CI9-20％），在妊娠期间进行内镜干预的比例为12%(95%CI8-17%).肝功能失代偿发生在7%(95%CI3-12%)。血小板减少是最常见的并发症（41%，95%CI23-60%）。流产发生率为14%（95%CI8-20%），27％的早产（95％CI19-37％），22％的低出生体重（95％CI15-30％）。产后出血的风险更高(RR5.09,95%CI1.84-14.12),与NCPH相比，CPH患者的静脉曲张出血较低（RR0.51，95％CI0.30-0.86）。各种结果的风险在NCPF和EHPVO之间是相当的。
结论：十分之一的妊娠合并门静脉高压症在妊娠期被诊断，血小板减少是最常见的并发症。肝脏代偿失调和静脉曲张破裂出血仍然是孕产妇死亡的最常见原因。在怀孕期间引入内窥镜手术后，出血率及其并发症的发生率降低。CPH增加产后出血的风险，而NCPH中静脉曲张出血较高。
