Gynecology World Conference 2026

Abstract

Background: Pregnancy in women with liver cirrhosis is uncommon because chronic liver dysfunction may impair fertility. When pregnancy occurs, physiologic changes such as increased plasma volume and portal venous pressure may precipitate hepatic decompensation, variceal bleeding, ascites, and adverse perinatal outcomes.

Case: We report the case of a 25-year-old primigravida with liver cirrhosis secondary to hepatobiliary tuberculosis, previously complicated by portal hypertension and esophageal varices requiring endoscopic band ligation. She first presented at 15 weeks’ gestation with jaundice and was initially classified as having compensated cirrhosis, with a Child-Pugh score of 6. She was managed through multidisciplinary care involving obstetrics, perinatology, gastroenterology, nutrition, anesthesiology, pediatrics, and infectious disease services. Her antenatal course was closely monitored with serial maternal assessment, liver function evaluation, fetal surveillance, nutritional support, anemia correction, and beta-blocker therapy. At 34 weeks’ gestation, she developed features of hepatic decompensation, including worsening jaundice, ascites, pedal edema, vomiting, dyspnea, and tea-colored urine. Fetal surveillance showed early-onset fetal growth restriction. At 35 weeks and 3 days, non-reassuring fetal status prompted abdominal delivery under general anesthesia. Intraoperatively, 5 liters of ascitic fluid were drained. A live preterm male neonate, small for gestational age and weighing 1,200 g, was delivered with APGAR scores of 9 and 9. The mother remained hemodynamically stable postpartum and was discharged on postoperative day six with continued gastroenterology follow-up and contraception counseling.

Conclusion: This case highlights that even initially compensated cirrhosis may decompensate during pregnancy. Favorable maternal and neonatal outcomes are possible with early risk stratification, close fetal and hepatic monitoring, individualized delivery planning, and coordinated multidisciplinary management.