Pregnancy and esophageal varices

A review of the case histories of 53 patients with established cirrhosis who had 83 pregnancies and 38 noncirrhotic patients with varices who had 77 pregnancies suggests that conception may occur in patients with varying degrees of hepatic decompensation, that sustaining gestation to term and delivery is unlikely to overtax cirrhotic livers in patients who are able to conceive, that infertility does not necessarily follow portal decompression operations, that fatal hemorrhage from preexisting esophageal varices is not more likely to occur during gestation, that variceal hemorrhage during pregnancy is not predictable on the basis of individual history of bleeding, and that the risk of variceal bleeding is not increased during vaginal delivery. Management of the rare patient with the combination of inactive cirrhosis, portal hypertension and esophageal varices requires a high degree of individualization. The strong desire for a child must be balanced against acceptance of an indeterminate prognosis of intrinsic liver disease, the possible need to terminate pregnancy in the presence of progressive hepatic decompensation, and termination of pregnancy when the potential for fetal abnormality resulting from serious hemorrhage early in gestation is significant. Under these circumstances and with currently available methods for the control of active variceal bleeding, a nihilistic approach cannot be justified.