# Liver Cirrhosis in Pregnancy and Its Fetal Outcomes: A Prospective Case Series

## TL;DR

Pregnancy in women with liver cirrhosis is rare and risky, but coordinated care can lead to good outcomes for both mother and baby.

## Contribution

This case series demonstrates successful multidisciplinary management of cirrhotic pregnancies with favorable maternal and fetal outcomes.

## Key findings

- Multidisciplinary care prevented complications like variceal hemorrhage and hepatic encephalopathy in cirrhotic pregnancies.
- All neonates were liveborn with good Apgar scores, and one case of growth restriction was managed successfully.
- Hepatitis B prophylaxis effectively prevented vertical transmission in affected pregnancies.

## Abstract

Pregnancy in women with cirrhosis is uncommon and carries substantial maternal and fetal risks, yet outcomes may improve with coordinated multidisciplinary care. We prospectively followed three pregnant women with confirmed cirrhosis between January 2023 and June 2024 in a tertiary hepatology-maternal-fetal medicine clinic. Management strategies included disease severity assessment, targeted endoscopy, beta-blockers for portal hypertension, antiviral therapy for hepatitis B, hematologic optimization, and individualized delivery planning. Two women had compensated cirrhosis without portal hypertension, and one had a history of decompensation with persistent portal hypertension. Deliveries comprised two cesarean sections, one for pathological cardiotocography and one for failed trial of labor, and one induced vaginal birth following platelet transfusion. No cases of variceal hemorrhage, hepatic encephalopathy, or maternal death occurred. All neonates were liveborn with Apgar scores of 9 at one and five minutes; one had growth restriction. At six weeks postpartum, all mothers remained clinically stable, and hepatitis B prophylaxis prevented vertical transmission. This case series highlights that multidisciplinary management enables favorable outcomes in selected cirrhotic pregnancies.