Bleeding from oesophageal varices has been reported in 50 % of pregnant women with portal hypertension.1 Variceal bleeding during pregnancy is associated with a mortality rate of 18-50% in women with cirrhosis, though pregnant women with non-cirrhotic portal hypertension (NCPH) have much lower mortality rates between 2 and 6%.2 Pregnant women with cirrhosis are at risk of hepatic decompensation/encephalopathy, ascites and postpartum haemorrhage.
Pregnancy in women with portal hypertension is also associated with the risk of splenic artery aneurysm (SAA) rupture and of pulmonary hypertension. The prevalence of SAA varies from an estimated 0.1-0.2% in the general population to 7.1 % in autopsies on persons with cirrhotic portal hypertension.3 SAA occurs 4 times more often in women compared with men, is associated with pregnancy and risk increases with increasing parity.4 More than 400 cases of SAA rupture have been reported with approximately 30 % of these being during pregnancy.5 SAA rupture is associated with maternal and fetal mortality rates of 70 % and 90 % respectively.6 There is an estimated 25 % risk of rupture in pregnancy in women with an existing SAA.
The appropriate management of SAA during pregnancy is unclear. While current recommendations advise management with SAA greater than 2 cm in diameter, more than half of SSAs which rupture during pregnancy are smaller in size, leading some authors to recommend treatment of all SAA regardless of size in women of childbearing age.7
A prospective study of patients hospitalised with portal hypertension detected pulmonary hypertension in 2 per cent.8 Pulmonary hypertension complicating pregnancy is associated with significant maternal mortality of between 12 % and 33 %.9
A case of SAA in a woman with NCPH is presented. Health professionals caring for women with portal hypertension in pregnancy should be aware of the risks of SAA and pulmonary hypertension.