Introduction: Liver diseases complicate approximately 3% of the pregnancies worldwide, and require specialized care to ensure optimal pregnancy outcomes. Extra-hepatic portal venous obstruction (EHPVO), though asymptomatic in a majority of the cases, has a higher risk of variceal bleeding in pregnancy and adverse pregnancy outcomes. In this series, we describe five cases of EHPVO presenting in pregnancy to our tertiary care hospital, their antenatal management as well as delivery outcomes.

Cases: In our case series on EHPVO in pregnancy, a majority of the women were diagnosed during childhood and adequately asymptomatic prior to pregnancy. Two women underwent Endoscopic band ligation of esophageal varices and one woman underwent splenectomy before pregnancy for disease control. One woman was Anti-nuclear antibody (ANA) positive and one woman was Anti-phospholipid antibody (APLA) positive, while the other three did not have pre-existing thrombotic tendencies. One patient required Endoscopic band ligation during the course of pregnancy. Hypertension complicating pregnancy was noted in two of the five women (40%). Four of the five women (80%) had thrombocytopenia requiring blood products during delivery.

Two women underwent preterm vaginal delivery, and one woman underwent preterm Caesarean section in view of abruptio placenta. Three women had post-partum haemorrhage, which was managed adequately with uterotonics and blood products. All five women and their neonates were discharged in healthy condition.

Conclusion: Multi-disciplinary approach with standardised antenatal care can give positive pregnancy outcomes in women with EHPVO.

Akshaya Murali has completed her MS in Obstetrics and Gynecology from JIPMER, India and is currently working as a Gynecologist in St. John’s Medical College, Bangalore, India. She has completed a degree in Hospital Management from IIM-B. She has a number of national and international publications, and has authored a chapter in a book on Preeclampsia. Her interests are Fetal Medicine and High risk Obstetrics.