Pregnancy in a patient with portal hypertension secondary to liver cirrhosis

This case report is of a 32-year-old woman of African descent on follow-up for pregnancy in the background of portal hypertension due to liver cirrhosis. She had initially been treated for chronic hepatitis B infection with lamivudine and tenofovir, complicated by portal hypertension and variceal bleeding that thrice required banding. Her pregnancy was uneventful until 31 weeks gestation when she presented with dyspnoea. On examination and investigation, she had oedema, bilateral pleural effusions and ascites. Multidisciplinary discussions involving surgery, anaesthesia, obstetrics, neonatology and medicine were held. A consensus outpatient and inpatient management plan was implemented. At 36 weeks, following non-reassuring fetal cardiotocography, she underwent induction of labour. An assisted vacuum delivery was conducted in a controlled setting. She gave birth to a live female infant who had an APGAR score of 9 at 5 min. Both she and the baby had an uneventful postpartum period.