15Nov 2019

HYPERTENSION PORTALE ET GROSSESSE : EXPERIENCE DU SERVICE DE GYNECOLOGIE-OBSTETRIQUE II DU CHU HASSAN II DE FES, A PROPOS DE CINQ CAS COLLIGES DURANT LANNEE 2017 - 2018

  • Centre Hospitalier et Universitaire Hassan II de Fes: Faculte de Medecine et Pharmacie de Fes.B.P: 1893, KM 2.200, Rte Sidi Harazem, Fes 30070, Maroc
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Portal hypertension on cirrhotic liver or not, when it is well supported; improves the vital prognosis in view of the hemorrhagic complications that it incurs. Thus, any woman before conception should consult her gastroenterologist in order to predispose to an armed follow-up in association with an obstetrician. Because the presence of a pregnancy in a woman with portal hypertension is a high-risk period, which can have a maternal-fetal prognosis. This risk can lead to maternal death, miscarriage, fetal death in utero or even prematurity or peri-and post-natal death. However, primary prevention is proposed in these patients, in order to act upstream on esophageal varices either by cardi-selective beta-blockers or by endoscopic ligation. The modalities of delivery will be discussed as appropriate. Although the lower lane is preferred, caesarean section also has its place, especially in purely obstetric indications. Thus the coalition of anesthesia staff, of neonatology in concomitance with gastroenterologists and obstetricians would be codified. For it will also be necessary to discuss the type of analgesia for which delivery route. To this end, we wanted to highlight our experience on the peculiarity of management of these pregnancy states collected within the gynecology-obstetrics department II of CHU Hassan II of Fes about five patients. A prospective study followed during the year 2017-2018. Two of the women were treated in delivery room with a strict minimum balance, while the other three were well followed with multidisciplinary care in collaboration with gastroenterologists, anesthetists and pediatricians


  1. Cheng YS. Pregnancy and liver cirrhosis and/or portal hypertension. Am J Obstet and Gynecol 1977; 128: 812-22.
  2. Restaino A, Compabasso C, D?Aloya A, Abbruzzese AD, Valerio A, Pansini F. Cirrhosis and pregnancy. A case report and review of the literature. Clin Exp and Obstet Gynecol 1996; 23:240-7.
  3. Maurey A, Bernuau J, Ganne N, Uzzan M, Mandelbrot L, Colau JC, et al. La grossesse est possible chez les femmes atteintes de cirrhose. Gastroenterol Clin Biol 2006?; 30?: 1064.
  4. Rautou PE, Angermayr B, Raffa S, Peck-Radosavljevic M, Garcia-Pagan JC, Moucari R, et al. Maternal and fetal outcome in 27 women with Budd-Chiari syndrome and 41 pregnancies. Hepatology 2007; 46: 736A.
  5. Varma RR, Michelsohn NH, Borkowf HI, Lewis JD. Pregnancy in cirrhotic and noncirrhotic portal hypertension. Obstet Gynecol 1977; 50: 217-22.
  6. Schreyer P, Caspi E, El-Hindi JM, Eshchar J. Cirrhosis-pregnancy and delivery: a review. Obstet Gynecol Surv 1982; 37: 304-12.
  7. Pajor A, Lehoczky D. Pregancy in liver cirrhosis. Assessment of maternal and fetal risks in eleven patients and review of the management. Gynecol Obstet Invest 1994; 38: 45-50.
  8. Russell MA, Craigo MD. Cirrhosis and portal hypertension in pregnancy. Semin Perinatol 1998; 22: 156-65.
  9. Gines P, Cardenas A, Arroyo V, et al. Management of cirrhosis and ascites. N Engl J Med 2004; 350: 1646-54.
  10. Sanyal AJ, Bosch J, Blei A, et al. Portal hypertension and its complications. Gastroenterology 2008; 134: 1715-28.
  11. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet 2008; 371: 838-51.
  12. Runyon BA. Management of adult patients with ascites due to cirrhosis: An update. Hepatology 2009; 49: 2087-107.
  13. EASL Clinical Practice Guideline. Management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53: 397-417.
  14. Errharhay S, Chaara H, Lahmine A, Oudghiri B, Ibrahimi A, Melhouf M-A, Banani A. Hypertension portale et grossesse. A propos de cinq cas et revue de la litterature. Journal Africain d?Hepato-Gastro-Enterologie, Mars 2009, volume 3, issue 1, pp 22-25.
  15. Belaazri S, Lamine FZ, Siati A, Zeraidi N, Baidada A, Kharbach A. Portal Hypertension and Pregnancy: Three cases. International Annals of Medicine. 2017; 1(4).
  16. Harandou M, Ifkharen B, Madani N, Khatouf M, Kanjaa N. Hypertension portale et grossesse ? propos de cinq cas. Cah Anesthesiol 2005?; 53(2)?: 93-96.
  17. Maanani M, Zraidi M, Alami A, El Amrani S, Ouazzani MC. Hypertension portale et grossesse ? propos de trois observations. Esperance medicale, tome 8 N?74?: 349-351, 2001.
  18. El Idrissi F, Harandou M, Mohammadi M, El-Idrissi-Lamghari K, Benabed Kn Lachkar H, Belkhadir J, Benaissa A. Hypertension portale et grossesse ? propos d?une observation. Medecine du Maghreb, N?61,1997.
  19. Godat S, Antonio A.T, Delahvi M-A, Moradpour D, Doerig C. Hypertension portale et prise en charge de l?ascite. Rev Med Suisse 2012?; 8?: 1665-8.
  20. Tiribelli C, Rigato I. Liver cirrhosis and pregnancy. Ann Hepatol 2006; 5: 201.
  21. Tan J, Surti B, Saab S. Pregnancy cirrhosis. Liver transplant 2008; 14: 1081-91.
  22. Kenyon PA, Girling JC, Girling C. Liver disease in pregnancy Women?s. Health Medicine 2005; 2: 26-8.
  23. Crepin G, Querleu D, Bigant C, et al. Cirrhose hepatique et grossesse. Med.Chir.Dig 1977?; 6?: 127-135.
  24. Pauzner D, Wolman I, Niv D, Ber A, David MP. Endoscopic sclerotherapy in extrahepatic portal hypertension in pregnancy. Am J Obstet Gynecol 1991; 164: 152-3.
  25. Pajor A, Lehoczky D. Pregnancy and extrahepatic portal hypertension. Review and report on the management. Gynecol Obstet Invest 1990; 30: 193-7.
  26. Aggarwal N, Sawhney H, Vasishta K, Dhiman RK, Chawla Y. Non-cirrhotic portal hypertension in pregnancy. Int J Gynaecol Obstet 2001; 72: 1-7.
  27. Lee WM. Pregnancy in patients with chronic liver disease. Gastroenterol Clin North Am 1992; 21: 889-903.
  28. Bergeret S, Loffredo P, Bosson PL, Palot M, Seebacher J, Benhamou D,et al. Enqu?te nationale sur les alternatives ? l?analgesie peridurale obstetricale. Ann F Anest Reanim 2000?; 19?: 530-9.
  29. Evron S, Glezerman M, Sadan O, Boaz M, Ezri T. Remifentanil: a novel systemic analgesic for labor pain. Anesth Analg 2005; 100: 233-8.
  30. D?Alteroche L, Perarnau J-M, Perrotin F, Bacq Y. Grossesse et Hypertension portale. Gastroenterologie Clinique et Biologique 2008?; 32?: 541-546.
  31. Agence Fran?aise de Securite sanitaire des produits de sante. Transfusion de plasma frais congele. Produits, indications. Recommandations, Septembre 2002. http?: // agmed.sante.gouv.fr / pdf/5/rbp/tpfreco.pdf.

[Nyingone S, Kriouile M, Chaara H, Fdili Alaoui F-Z, Jayi S and Melhouf (2019); HYPERTENSION PORTALE ET GROSSESSE : EXPERIENCE DU SERVICE DE GYNECOLOGIE-OBSTETRIQUE II DU CHU HASSAN II DE FES, A PROPOS DE CINQ CAS COLLIGES DURANT LANNEE 2017 - 2018 Int. J. of Adv. Res. 7 (Nov). 177-182] (ISSN 2320-5407). www.journalijar.com


NYINGONE Solène
médecin résident en gynécologie Obstétrique au CHU Hassan II Fès-Maroc

DOI:


Article DOI: 10.21474/IJAR01/9991      
DOI URL: http://dx.doi.org/10.21474/IJAR01/9991