Esophageal varices in pregnancy: Strategies to optimize maternal and fetal outcomes

Table 1 Maternal and fetal risks associated with portal hypertension in pregnancy

Risk	Mechanism/description
Maternal risks
Variceal bleeding	Peak incidence in the 2nd and 3rd trimesters; triggered by increased portal venous flow and intra-abdominal pressure
Hepatic decompensation	Higher risk in advanced cirrhosis; manifestations include jaundice, ascites, and hepatic encephalopathy
Thrombocytopenia and coagulopathy	Caused by hypersplenism and reduced hepatic synthesis of clotting factors
HRS	Rare but potentially fatal; precipitated by fluid shifts, infection, or preeclampsia
Infections	Includes SBP and UTIs; risk increased by immune dysregulation
PPH	Increased due to varices, coagulopathy, and portal hypertension-related splenic sequestration of platelets
Fetal risks
FGR	Due to uteroplacental insufficiency, chronic maternal hypoxia, and hepatic dysfunction
Preterm delivery	May result from spontaneous labour or iatrogenic delivery following maternal complications
Increased perinatal mortality	Reported rates up to 20% in older studies; currently lower with improved maternal and neonatal care

HRS: Hepatorenal syndrome; SBP: Spontaneous bacterial peritonitis; UTI: Urinary tract infection; PPH: Postpartum hemorrhage; FGR: Fetal growth restriction.