Maternal prognosis with esophageal varices largely depends on whether these rupture. Mortality rates are higher if varices are associated with cirrhosis compared with rates for varices without cirrhosis-18 versus 2 percent, respectively. Perinatal mortality rates are high in women with varices and are worse if cirrhosis caused the varices. Increased rates of neonatal demise, preterm birth, low birthweight, preeclampsia, and postpartum hemorrhage have been reported (Puljic, 2016).
Treatment is the same as for nonpregnant patients. Preventatively, all patients with cirrhosis, including pregnant women, should undergo endoscopic screening for identification of variceal dilatation (Bacon, 2015). Beta-blocking drugs such as propranolol are given to reduce portal pressure and hence the bleeding risk (Bissonnette, 2015; Tran, 2016).
For acute bleeding and for prophylaxis, endoscopic band ligation is preferred to sclerotherapy as it avoids any potential risks of injecting sclerotherapeutic chemicals (Bissonnette, 2015; Tan, 2008). Acute medical management for bleeding varices veriied endoscopically includes the intravenous (IV) vasoconstrictors octreotide or somatostatin along with endoscopic banding. Vasopressin is less often used (Bacon, 2015). Baloon tamponade using a triple-lumen tube placed into the esophagus and stomach to compress bleeding varices can be lifesaving if endoscopy is not available. An interventional radiology procedure-tranjugular intrahepatic portosystemic stent shunting (TIPSS)-can also control bleeding from gastric varices that is unresponsive to other measures (Bissonnette, 2015; Tan, 2008). This procedure can be done electively in patients with prior variceal hemorrhage.
This drug is the most common cause of acute liver failure in the United States (Lee, 2013). Acetaminophen is often used during pregnancy, and overdose-either accidentally or by attempted suicide-may lead to hepatocellular necrosis and acute liver failure (Bunchorntavakul, 2013). Massive necrosis causes a cytokine storm and multiorgan dysfunction. Early symptoms of overdose are nausea, vomiting, diaphoresis, malaise, and pallor. With an acute overdose, after a latent period of 24 to 48 hours, liver failure ensues and usually begins to resolve in 5 days. In a prospective Danish study, only 35 percent of patients who were treated for fulminant hepatic failure spontaneously recovered before being listed for liver transplantation (Schmidt, 2007).