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Abstract
L’hémorragie digestive haute (HDH) par rupture des varices œsophagiennes (RVO) est une complication grave de la cirrhose. La prise en charge sur grossesse est mal codifiée. Nous rapportons le cas d’une HDH par RVO révélant une cirrhose sur grossesse. Il s’agit d’une multigeste âgée de 22 ans à 26 semaines d’aménorrhée (SA) gravidique qui a été admise en urgence pour une HDH. Les explorations ont été en faveur d’une RVO révélant une cirrhose virale B. En dépit du traitement, nous observerons une récidive hémorragique à la 38ème SA qui va aboutir à l’expulsion d’un mort-né. L’endoscopie digestive réalisée après l’accouchement a retrouvé une régression des signes endoscopiques d’hypertension portale.
ABSTRACT
An upper gastrointestinal bleeding (UGIB) secondary to a rupture of esophageal varices is a severe complication of cirrhosis. The treatment on pregnancy is poorly described. Here we reported a case of an UGIB due to a rupture of esophageal varices revealing a cirrhosis in pregnancy. There was a multipara of 22-year-old on 26-weeks of pregnancy. She has been admitted in emergency for an UGIB. The exploration revealed a rupture of esophageal varices on hepatitis B related cirrhosis. Despite the treatment, another UGIB happens on the 38th week and ended the pregnancy with a stillborn. The gastroscopy realized after the delivery observe the regression of portal hypertension signs.
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References
- Itoudi Bignoumba PE, Maganga Moussavou IF, Eyi Nguema AG, Minkobame U, Moussavou Kombila JB. Grossesse et cirrhose : à propos de 7 cas suivis au Centre Hospitalier Universitaire de Libreville. Bull Med Owendo. 2022; 20 (51): 75-9.
- Rasheed SM, Abdel Monem AM, Abd Ellah AH, Abdel Fattah MS. Prognosis and determinants of pregnancy outcome among patients with post-hepatitis liver cirrhosis. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2013;121(3): 247‑51.
- Venuto RV, Cox JW, Stein JH, Ferris TF. The effect of changes in perfusion pressure on uteroplacental blood flow in the pregnant rabbit. J Clin Invest. 1976; 57(4): 938-44.
- El Idrissi F, Harandou M, Mohammadi M et al. Hypertension portale et grossesse à propos d’une observation. Méd Maghreb 1997 ;(61) :19-22.
- Bagny A, Akolly DAE, Lawson-Ananisoh LM et al. Pregnancy and cirrhosis: four cases at the Lome campus university teaching hospital (Togo). Med Sante Trop 2016; 26(4): 382-5.
- van der Slink LL, Scholten I, van Etten-Jamaludin FS, Takkenberg RB, Painter RC. Pregnancy in women with liver cirrhosis is associated with increased risk for complications: A systematic review and meta-analysis of the literature. BJOG Int J Obstet Gynaecol. 2022;129(10):1644‑52.
- Mullin M, Djerboua M, Sarkar M, Lu J, Velez MP, Brogly S, et al. Pregnancy Is Not Associated with an Increased Risk of Decompensation, Transplant, or Death in Compensated Cirrhosis. Int J Hepatol. 2022; 2022:9985226.
- Flemming JA, Mullin M, Lu J, Sarkar MA, Djerboua M, Velez MP, et al. Outcomes of Pregnant Women With Cirrhosis and Their Infants in a Population-Based Study. Gastroenterology. 2020;159(5):1752-62.
- Westbrook RH, Yeoman AD, O’Grady JG, Harrison PM, Devlin J, Heneghan MA. Model for end-stage liver disease score predicts outcome in cirrhotic patients during pregnancy. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc.2011;9(8):694‑9.
- Tan J, Surti B, Saab S. Pregnancy and cirrhosis. Liver Transpl. 2008; 14:1081-91
- Rahim MN, Pirani T, Williamson C, Heneghan MA. Management of pregnancy in women with cirrhosis. United Eur Gastroenterol J. 2021;9(1):110‑9.
- Ghidirim G, Mishin I, Dolghii A, Lupashcu A. Prophylactic endoscopic band ligation of esophageal varices during pregnancy. J Gastrointest Liver Dis JGLD.2008;17(2):236‑7.
- Gao X, Zhu Y, Liu H, et al. Maternal and fetal outcomes of patients with liver cirrhosis: a case-control study. BMC Pregnancy Childbirth 2021; 21(1):280.
References
Itoudi Bignoumba PE, Maganga Moussavou IF, Eyi Nguema AG, Minkobame U, Moussavou Kombila JB. Grossesse et cirrhose : à propos de 7 cas suivis au Centre Hospitalier Universitaire de Libreville. Bull Med Owendo. 2022; 20 (51): 75-9.
Rasheed SM, Abdel Monem AM, Abd Ellah AH, Abdel Fattah MS. Prognosis and determinants of pregnancy outcome among patients with post-hepatitis liver cirrhosis. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2013;121(3): 247‑51.
Venuto RV, Cox JW, Stein JH, Ferris TF. The effect of changes in perfusion pressure on uteroplacental blood flow in the pregnant rabbit. J Clin Invest. 1976; 57(4): 938-44.
El Idrissi F, Harandou M, Mohammadi M et al. Hypertension portale et grossesse à propos d’une observation. Méd Maghreb 1997 ;(61) :19-22.
Bagny A, Akolly DAE, Lawson-Ananisoh LM et al. Pregnancy and cirrhosis: four cases at the Lome campus university teaching hospital (Togo). Med Sante Trop 2016; 26(4): 382-5.
van der Slink LL, Scholten I, van Etten-Jamaludin FS, Takkenberg RB, Painter RC. Pregnancy in women with liver cirrhosis is associated with increased risk for complications: A systematic review and meta-analysis of the literature. BJOG Int J Obstet Gynaecol. 2022;129(10):1644‑52.
Mullin M, Djerboua M, Sarkar M, Lu J, Velez MP, Brogly S, et al. Pregnancy Is Not Associated with an Increased Risk of Decompensation, Transplant, or Death in Compensated Cirrhosis. Int J Hepatol. 2022; 2022:9985226.
Flemming JA, Mullin M, Lu J, Sarkar MA, Djerboua M, Velez MP, et al. Outcomes of Pregnant Women With Cirrhosis and Their Infants in a Population-Based Study. Gastroenterology. 2020;159(5):1752-62.
Westbrook RH, Yeoman AD, O’Grady JG, Harrison PM, Devlin J, Heneghan MA. Model for end-stage liver disease score predicts outcome in cirrhotic patients during pregnancy. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc.2011;9(8):694‑9.
Tan J, Surti B, Saab S. Pregnancy and cirrhosis. Liver Transpl. 2008; 14:1081-91
Rahim MN, Pirani T, Williamson C, Heneghan MA. Management of pregnancy in women with cirrhosis. United Eur Gastroenterol J. 2021;9(1):110‑9.
Ghidirim G, Mishin I, Dolghii A, Lupashcu A. Prophylactic endoscopic band ligation of esophageal varices during pregnancy. J Gastrointest Liver Dis JGLD.2008;17(2):236‑7.
Gao X, Zhu Y, Liu H, et al. Maternal and fetal outcomes of patients with liver cirrhosis: a case-control study. BMC Pregnancy Childbirth 2021; 21(1):280.