Original article—liver, pancreas, and biliary tractModel for End-Stage Liver Disease Score Predicts Outcome in Cirrhotic Patients During Pregnancy
Section snippets
Patients and Methods
We reviewed all cirrhotic patients who reported pregnancy at our institution between 1984 and 2009. Patients were identified from a prospectively collated liver database using the search terms pregnancy, cirrhosis, abortion, miscarriage, and termination. The clinical records were reviewed in all patients and data extracted in a standard fashion. The diagnosis of cirrhosis was made histologically or using a combination of radiological and laboratory investigations in cases where a biopsy was not
Results
There were 62 pregnancies in 29 cirrhotic women, where all clinical information was available to calculate prognostic scores. Scores were calculated from clinical information at the clinic visit immediately prior to pregnancy being reported (median 3 months from conception [range, 1–6 months]). Cirrhosis was diagnosed on liver biopsy in 41/62 (66%) and by radiological and laboratory parameters in 21/62 (34%). The underlying diagnosis was autoimmune (n = 27), alcohol-related (n = 10), viral (n =
Discussion
In this study, we have identified that pregnancy in patients with cirrhosis carries a high incidence of maternal morbidity, occurring in 10% of pregnancies. A live birth rate of 58% is observed with 75% of neonates born prematurely and 17% of live births requiring neonatal intensive care unit. We have demonstrated that the prognostic scoring systems of MELD, MELD-Na, UKELD, and CP scores at the time of conception can be used to predict certain outcomes and complications that may be encountered
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This article has an accompanying continuing medical education activity on page e84. Learning Objectives—At the end of this activity, the learner should distinguish models that are prognostic for outcomes in pregnant women with cirrhosis.
Conflicts of interest The authors disclose no conflicts.