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

Table 2 Predictors of adverse maternal and fetal outcomes

Category	Predictor	Implication
Maternal	History of variceal bleeding	Strongest predictor of peripartum hemorrhage
Maternal	Large esophageal varices	> 30% risk of bleeding in late 2nd or 3rd trimester
Maternal	Thrombocytopenia (< 50000/mm³)	Indicates hypersplenism and coagulopathy
Maternal	Coagulopathy (INR > 1.5)	Increases hemorrhagic risk during delivery
Maternal	Ascites	Marker of hepatic decompensation; predicts poor maternal outcomes
Maternal	Hepatic encephalopathy	Sign of end-stage liver disease
Maternal	Portal vein thrombosis	May worsen hepatic congestion and complicate delivery
Fetal	Maternal cirrhosis	Associated with placental insufficiency, preterm labour, and fetal loss
Fetal	Hypoalbuminemia	Indicates poor hepatic reserve and suboptimal nutritional status
Fetal	Beta-blocker therapy	Potential for FGR and bradycardia
Fetal	Acute variceal bleeding episodes	May cause fetal distress and hypoxia
Fetal	Preterm delivery	Often iatrogenic due to maternal decompensation

INR: International normalized ratio; FGR: Fetal growth restriction.