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Pregnancy outcomes in women with Budd-Chiari syndrome or portal vein thrombosis - A multicentre retrospective cohort study
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  • Hanke Wiegers,
  • Eva N. Hamulyák,
  • Stefanie E. Damhuis,
  • Jack R. Duuren,
  • Sarwa Darwish Murad,
  • Luuk J.J. Scheres,
  • Sanne Gordijn,
  • Jenneke Leentjens,
  • Johannes Duvekot,
  • Mandy N. Lauw,
  • Barbara Hutten,
  • Saskia Middeldorp,
  • Wessel Ganzevoort
Hanke Wiegers
Amsterdam UMC Locatie AMC
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Eva N. Hamulyák
Amsterdam UMC Locatie AMC
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Stefanie E. Damhuis
Amsterdam UMC Locatie AMC
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Jack R. Duuren
Amsterdam UMC Locatie AMC
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Sarwa Darwish Murad
Erasmus MC
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Luuk J.J. Scheres
Radboudumc
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Sanne Gordijn
UMCG
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Jenneke Leentjens
Radboudumc
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Johannes Duvekot
Erasmus MC
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Mandy N. Lauw
Erasmus MC
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Barbara Hutten
Amsterdam UMC Locatie AMC
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Saskia Middeldorp
Radboudumc
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Wessel Ganzevoort
Academic Medical Center
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Abstract

Objective: to evaluate current practice and outcomes of pregnancy in women previously diagnosed with Budd-Chiari syndrome and/or portal vein thrombosis, with and without concomitant portal hypertension. Design and setting: multicentre retrospective cohort study between 2008-2021 Population: Women who conceived in the predefined period after the diagnosis of Budd-Chiari syndrome and/or portal vein thrombosis Methods and main outcome measures: We collected data on diagnosis and clinical features. The primary outcomes were maternal mortality and live birth rate. Secondary outcomes included maternal, neonatal and obstetric complications. Results: Forty-five women (12 Budd-Chiari syndrome, 33 portal vein thrombosis; 76 pregnancies) were included. Underlying prothrombotic disorders were present in 23 of 45 women (51%). Thirty-eight women (84%) received low-molecular-weight heparin during pregnancy. Of 45 first pregnancies, 11 (24%) ended in pregnancy loss and 34 (76%) resulted in live birth of which 27 at term age (79% of live births and 60% of pregnancies). No maternal deaths were observed, one woman developed pulmonary embolism during pregnancy and two women (4%) had variceal bleeding requiring intervention. Conclusions: The high number of term live births (79%) and lower than expected risk of pregnancy-related maternal and neonatal morbidity in our cohort suggest that Budd-Chiari syndrome and/or portal vein thrombosis should not be considered as an absolute contra-indication for pregnancy. Individualized, nuanced counselling and a multidisciplinary pregnancy surveillance approach are essential in this patient population.

Peer review status:ACCEPTED

12 May 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
17 May 2021Submission Checks Completed
17 May 2021Assigned to Editor
17 May 2021Reviewer(s) Assigned
21 Jun 2021Review(s) Completed, Editorial Evaluation Pending
27 Jul 2021Editorial Decision: Revise Major
25 Aug 20211st Revision Received
26 Aug 2021Submission Checks Completed
26 Aug 2021Assigned to Editor
26 Aug 2021Review(s) Completed, Editorial Evaluation Pending
29 Aug 2021Editorial Decision: Accept