Pregnancy and cirrhosis: management of hematemesis by Warren shunt during third trimester gestation.

International journal of obstetric anesthesia

PubMedID: 15636925

Duke J. Pregnancy and cirrhosis: management of hematemesis by Warren shunt during third trimester gestation. Int J Obstet Anesth. 1994;3(2):97-102.
Considerable pathophysiologic changes accompany cirrhosis. Elevation of portal venous pressure predisposes to esophageal varices and hematemesis. The physiologic changes associated with pregnancy may exacerbate these conditions. Medical management of cirrhosis-associated problems may fail, necessitating surgical intervention. The anesthetic management of a pregnant cirrhotic patient for a Warren shunt is complicated by concerns for pre-existing hepatic dysfunction and pregnancy-induced physiologic changes as well as fetal well-being. The management of such a case is reviewed and relevant pathophysiology discussed.