Caesarean section in a patient with chronic portal vein thrombosis and thrombocytopenia: Case report
Keywords:
Anesthesia, Cesarean section, Thrombocytopenia, Pregnancy abdominal, Thrombosis
Abstract
We report the case of a pregnant woman at term with primary anti-phospholipid syndrome, portal vein thrombosis, massive splenomegaly, oesophageal varices and thrombocytopenia. The patient underwent an elective caesarean section under general anaesthesia to minimise the risk of spleen and variceal rupture, with a favourable outcome for both the mother and the newborn.
Chronic portal vein thrombosis is a rare condition, caused by various reasons, mainly thrombotic diathesis. It leads to increased portal pressure, with development of collateral circulation, splenomegaly and thrombocytopenia. Pregnancy in these conditions is considered high risk, but is not contraindicated if the underlying disorder is stabilised. The management of these patients should be multidisciplinary, under close monitoring; diagnosis and treatment of possible oesophageal varices is essential. The decision about mode of delivery and anaesthetic management must be individualised, depending on obstetric factors, the presence or absence of varices and thrombocytopenia, and associated comorbidities.
References
1. Wax JR, Pinette MG, Cartin A, Winn SS, Blackstone J. Cavernous transformation of the portal vein complicating pregnancy. Obstet Gynecol. 2006;108:782-4.
2. Hoekstra J, Seijo S, Rautou PE, Ducarme G, Boudaoud L, Luton D, et al. Pregnancy in women with portal vein thrombosis: results of a multicentric European study on maternal and fetal management and outcome. J Hepatol. 2012;57:1214-9.
3. Donaldson LB, Plant RK. Pregnancy complicated by extrahepatic portal hypertension: review of literature and report of two cases. Am J Obstet Gynecol. 1971;110:255-64.
4. Aggarwal N, Negi N, Aggarwaly A, Bodhz V, Dhimanz RK. Pregnancy with portal hypertension. J Clin Exp Hepatol. 2014;4:163-71.
5. Aggarwal N, Sawhney H, Vasishta K, Dhiman RK, Chawla Y. Non-cirrhotic portal hypertension in pregnancy. Int J Gynaecol Obstet. 2001;72:1-7.
6. Jabiry-Zieniewicz Z, Dabrowski FA, Suchonska B, Kowalczyk R, Nowacka E, Kociszewska-Najman B, et al. Pregnancy and delivery in women with esophageal varices due to hepatic vein thrombosis. J Matern Fetal Neonatal Med. 2015;28:177-81.
7. Bissonnette J, Durand F, de Raucourt E, Ceccaldi PF, Plessier A, Valla D, et al. Pregnancy and vascular liver disease. J Clin Exp Hepatol. 2015;5:41-50.
8. Ducarme G, Plessier A, Thuillier C, Ceccaldi PF, Valla D, Luton D. Pregnancy and delivery in patients with portal vein cavernoma. Gynecol Obstet Invest. 2009;68:196-8.
9. Buyukbayrak EE, Ergen B, Karageyim Karsidag AY, Kars B, Turan C, Birtas Atesoglu E. Successful pregnancy in a patient with portal hypertension secondary to portal vein thrombosis due to essential thrombocythaemia: a rare case. J Matern Fetal Neonatal Med. 2010;23:187-9.
10. Kuczkowski KM. Controversies in the delivery suite: obstetrical anaesthesia for the parturient with cavernous transformation of the portal vein. Arch Gynecol Obstet. 2005;272:179-81.
11. Beilin Y, Zahan J, Comeford M. Safe epidural analgesia in thirty parturients with platelet count between 69000 and 98000/mm3. Anesth Analg. 1997;85:385-8.
12. Goodier CG, Lu JT, Hebbar L, Segal BS, Goetzl L. Neuraxial anesthesia in parturients with thrombocytopenia: a multisite retrospective cohort study. Anesth Analg. 2015;121:988-91.
13. Camann W. Obstetric neuraxial anesthesia contraindicated? Really? Time to rethink old dogma. Anesth Analg. 2015;121:846-8.
14. Goodier CG, Bernstein J, Hua B, Kahana M, Shaparin N, Yu S, et al. Neuraxial anesthesia in parturients with low platelet counts. Anesth Analg. 2016;123:165-7.
15. Frenk V, Camann W, Shankar KB. Regional anesthesia in parturients with low platelet counts. Can J Anaesth. 2005;52:114.
16. Tanaka M, Balki M, McLeod A, Carvalho JC. Regional anesthesia and non-preeclamptic thrombocytopenia: time to re-think the safe platelet count. Rev Bras Anestesiol. 2009;59:142-53.
17. Bernstein J, Hua B, Kahana M, Shaparin N, Yu S, Davila-Velazquez J. Neuraxial anesthesia in parturients with low platelet counts. Anesth Analg. 2016;123:165-7.
18. Huang J, McKenna N, Babins N. Utility of thromboelastography during neuraxial blockade in the parturient with thrombocytopenia. AANA J. 2014;82:127-30.
19. Estcourt LJ, Ingram C, Doree C, Trivella M, Stanworth SJ. Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia. Cochrane Database Syst Rev. 2016;5:CD011980.
2. Hoekstra J, Seijo S, Rautou PE, Ducarme G, Boudaoud L, Luton D, et al. Pregnancy in women with portal vein thrombosis: results of a multicentric European study on maternal and fetal management and outcome. J Hepatol. 2012;57:1214-9.
3. Donaldson LB, Plant RK. Pregnancy complicated by extrahepatic portal hypertension: review of literature and report of two cases. Am J Obstet Gynecol. 1971;110:255-64.
4. Aggarwal N, Negi N, Aggarwaly A, Bodhz V, Dhimanz RK. Pregnancy with portal hypertension. J Clin Exp Hepatol. 2014;4:163-71.
5. Aggarwal N, Sawhney H, Vasishta K, Dhiman RK, Chawla Y. Non-cirrhotic portal hypertension in pregnancy. Int J Gynaecol Obstet. 2001;72:1-7.
6. Jabiry-Zieniewicz Z, Dabrowski FA, Suchonska B, Kowalczyk R, Nowacka E, Kociszewska-Najman B, et al. Pregnancy and delivery in women with esophageal varices due to hepatic vein thrombosis. J Matern Fetal Neonatal Med. 2015;28:177-81.
7. Bissonnette J, Durand F, de Raucourt E, Ceccaldi PF, Plessier A, Valla D, et al. Pregnancy and vascular liver disease. J Clin Exp Hepatol. 2015;5:41-50.
8. Ducarme G, Plessier A, Thuillier C, Ceccaldi PF, Valla D, Luton D. Pregnancy and delivery in patients with portal vein cavernoma. Gynecol Obstet Invest. 2009;68:196-8.
9. Buyukbayrak EE, Ergen B, Karageyim Karsidag AY, Kars B, Turan C, Birtas Atesoglu E. Successful pregnancy in a patient with portal hypertension secondary to portal vein thrombosis due to essential thrombocythaemia: a rare case. J Matern Fetal Neonatal Med. 2010;23:187-9.
10. Kuczkowski KM. Controversies in the delivery suite: obstetrical anaesthesia for the parturient with cavernous transformation of the portal vein. Arch Gynecol Obstet. 2005;272:179-81.
11. Beilin Y, Zahan J, Comeford M. Safe epidural analgesia in thirty parturients with platelet count between 69000 and 98000/mm3. Anesth Analg. 1997;85:385-8.
12. Goodier CG, Lu JT, Hebbar L, Segal BS, Goetzl L. Neuraxial anesthesia in parturients with thrombocytopenia: a multisite retrospective cohort study. Anesth Analg. 2015;121:988-91.
13. Camann W. Obstetric neuraxial anesthesia contraindicated? Really? Time to rethink old dogma. Anesth Analg. 2015;121:846-8.
14. Goodier CG, Bernstein J, Hua B, Kahana M, Shaparin N, Yu S, et al. Neuraxial anesthesia in parturients with low platelet counts. Anesth Analg. 2016;123:165-7.
15. Frenk V, Camann W, Shankar KB. Regional anesthesia in parturients with low platelet counts. Can J Anaesth. 2005;52:114.
16. Tanaka M, Balki M, McLeod A, Carvalho JC. Regional anesthesia and non-preeclamptic thrombocytopenia: time to re-think the safe platelet count. Rev Bras Anestesiol. 2009;59:142-53.
17. Bernstein J, Hua B, Kahana M, Shaparin N, Yu S, Davila-Velazquez J. Neuraxial anesthesia in parturients with low platelet counts. Anesth Analg. 2016;123:165-7.
18. Huang J, McKenna N, Babins N. Utility of thromboelastography during neuraxial blockade in the parturient with thrombocytopenia. AANA J. 2014;82:127-30.
19. Estcourt LJ, Ingram C, Doree C, Trivella M, Stanworth SJ. Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia. Cochrane Database Syst Rev. 2016;5:CD011980.
How to Cite
1.
López Correa T, Sastre Rincón JA. Caesarean section in a patient with chronic portal vein thrombosis and thrombocytopenia: Case report. Colomb. J. Anesthesiol. [Internet]. 2017 Jul. 1 [cited 2024 Apr. 23];45(3):251–255. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/664
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Published
2017-07-01
How to Cite
1.
López Correa T, Sastre Rincón JA. Caesarean section in a patient with chronic portal vein thrombosis and thrombocytopenia: Case report. Colomb. J. Anesthesiol. [Internet]. 2017 Jul. 1 [cited 2024 Apr. 23];45(3):251–255. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/664
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Section
Case Report / Case Series
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