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Fetal and maternal outcomes often favorable in PVT

NEW YORK (Reuters Health) – Although non-cirrhotic portal vein thrombosis (PVT) increases the risk of untoward outcomes, pregnancy should not be formally contraindicated in women with stable PVT, according to European researchers.

“Pregnancy in PVT is possible but not completely without risks of miscarriage and pre-term birth,” Dr. Harry Janssen told Reuters Health by email. “With good clinical care the risk for the mother appears very low.”

Dr. Janssen, of Erasmus University Medical Center in Rotterdam, The Netherlands, and colleagues report their findings in a paper online August 9 in the Journal of Hepatology.

In order to define risks, the team retrospectively examined data on 45 pregnancies during follow-up of 24 women with PVT diagnosed at three European centers (France, Spain, and The Netherlands). Low-molecular-weight heparin was given in thirty pregnancies, whereas no anticoagulation therapy was used in the other 15 pregnancies.

Nine pregnancies (20%) were lost before gestational week 20. Of the 36 remaining pregnancies beyond this point, all resulted in live births, 26 of which were at term; seven births were moderately preterm and three were very preterm.

Cesarean section was used in 53% of deliveries. Overall, outcome was favorable in 29 (64%) of all pregnancies.

The rate of bleeding complications did not differ in patients who were treated with anticoagulation and those that were not. The rate of miscarriage, about 20%, is similar to that in another PVT report and is higher than the 10% to 15% expected in a healthy female population.

Compared to figures for the general French population both preterm delivery (38% versus 7%) and Cesarean section (53% versus 21%) were also strikingly higher.

Higher platelet count was significantly associated with unfavorable maternal outcomes. Of the 45 pregnancies, outcome was favorable in 29 cases (64%) and unfavorable in 16 (36%).

“Based on the findings in this study,” say the researchers, “it is not possible to reach a definite answer as to whether or not all patients with PVT should be treated with anticoagulation during pregnancy. Still, our results show mainly a favorable outcome.”

In PVT patients with prothrombotic conditions, or with thrombosis involving the mesenteric veins who are at greater risk of intestinal ischemia, they add, “anticoagulation therapy can be considered during pregnancy as recommended elsewhere for patients with other forms of thrombosis.”

Although pregnancy is a possibility, the researchers conclude, “patients should be accurately informed of fetal and maternal risk of such pregnancy.”

SOURCE: http://bit.ly/MCzM28

J Hepatol 2012.