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Portal hypertension, pregnancy risks
I'm 29 and was diagnosed 8 years ago with portal hypertension due to a chronic schistosoma infection (therefore had an enlarged spleen, ascites and jaundice at the time). Since then I've been taking a low (I believe) dosage of spironolactone, propranolol and furosemide to control my blood pressure and water retention.
Me & my man really want to have a baby within the next few years, and we're concerned about the possible complications/risks arising from this:
1. My menstrual cycle is very irregular (I often go several months without a period. Never been on the pill/injection etc. Never been pregnant)
2. Was rushed to hospital 5 months ago to have a bleeding oesophageal varix ligated. This was the first time I had a rupture but it could happen again.
3. My liver function is impaired (though to what extent I couldn't say). I bruise easily and there's some platelet issue - a bleeding cut takes a while to clot. My ankles occasionally puff up a bit after a long day.
4. I'm on a rather spare medical aid plan right now, so frequent visits to any kind of specialist are limited. I was advised to come in for a gastroscopy every 6 months. With pregnancy, would this be more often? Is it advisable for my gastroenterologist and (future) OB/GYN to communicate directly?
Before this year my 'condition' was sort of at the back of my mind, to be honest, so I haven't been particularly diligent, other than taking the medication. However I have had no major mishaps or setbacks until 5 months ago. I'm otherwise in ok shape, feel fine, take care of my body as best I can - eat fairly healthily, swim regularly, and don't drink at all anymore (I used to have a glass or 2 of wine fairly often).
I just wanted to know what to expect should I become pregnant. I'm in a longterm relationship and we have discussed all of this. I'm just worried with the recent bleed that maybe things are worsening and the chances of a traumatic pregnancy will escalate as time goes by. We really want to have a baby.
I was just hoping for an overall idea of what I'm facing, but mainly just to know how worried should I be.
Me & my man really want to have a baby within the next few years, and we're concerned about the possible complications/risks arising from this:
1. My menstrual cycle is very irregular (I often go several months without a period. Never been on the pill/injection etc. Never been pregnant)
2. Was rushed to hospital 5 months ago to have a bleeding oesophageal varix ligated. This was the first time I had a rupture but it could happen again.
3. My liver function is impaired (though to what extent I couldn't say). I bruise easily and there's some platelet issue - a bleeding cut takes a while to clot. My ankles occasionally puff up a bit after a long day.
4. I'm on a rather spare medical aid plan right now, so frequent visits to any kind of specialist are limited. I was advised to come in for a gastroscopy every 6 months. With pregnancy, would this be more often? Is it advisable for my gastroenterologist and (future) OB/GYN to communicate directly?
Before this year my 'condition' was sort of at the back of my mind, to be honest, so I haven't been particularly diligent, other than taking the medication. However I have had no major mishaps or setbacks until 5 months ago. I'm otherwise in ok shape, feel fine, take care of my body as best I can - eat fairly healthily, swim regularly, and don't drink at all anymore (I used to have a glass or 2 of wine fairly often).
I just wanted to know what to expect should I become pregnant. I'm in a longterm relationship and we have discussed all of this. I'm just worried with the recent bleed that maybe things are worsening and the chances of a traumatic pregnancy will escalate as time goes by. We really want to have a baby.
I was just hoping for an overall idea of what I'm facing, but mainly just to know how worried should I be.
Thank you for such a detailed response - this helps plenty!
No, I haven't yet consulted any specialists or even my GP about getting pregnant. I've just had these concerns and needed a starting point, hoping this will help me to better articulate my worries when the time comes. Soon, probably. You've given me quite a bit to think about :) and your reply is oddly reassuring. Thanks again.
No, I haven't yet consulted any specialists or even my GP about getting pregnant. I've just had these concerns and needed a starting point, hoping this will help me to better articulate my worries when the time comes. Soon, probably. You've given me quite a bit to think about :) and your reply is oddly reassuring. Thanks again.
Your gastroenterologist and your OBGYN would need to communicate directly to develop a plan for you. Have you had an appointment with the OBGYN yet to discuss the risks associated with pregnancy? I highly recommend having a detailed conversation with both specialists.
Some of your medications may need to be changed, I was taking propanolol (among other beta blockers) and was told metoprolol was the safest to take while pregnant. Procardia is also one that they allow. Im not sure about your water pills but I know that those are sometimes given when the benefits outweigh the risks.
I think one of your biggest hurdles will be your bleeding/clotting issues. Since you are at such a high risk for bleeding in general, you would definitely be considered high risk during pregnancy. Your risk is not only at delivery (which could ideally be in a controlled environment where they could CLOSELY monitor you) but also at other points in the pregnancy.
You have a history of ruptured varacies, so I would think that with the increased blood volume that accompanies pregnancy, your vessels would be at an even higher risk for rupture.
People with unique medical issues get pregnant everyday, but I would definitely make an appointment with the gastro and the OBGYN before trying to get pregnant to make sure that you will be able to carry a baby to term without endangering you or the baby. Also, they may want to start making medication changes before you get pregnant to avoid complications that could arise with the fetus very early in pregnancy.
I truly wish you the best of luck!!
Some of your medications may need to be changed, I was taking propanolol (among other beta blockers) and was told metoprolol was the safest to take while pregnant. Procardia is also one that they allow. Im not sure about your water pills but I know that those are sometimes given when the benefits outweigh the risks.
I think one of your biggest hurdles will be your bleeding/clotting issues. Since you are at such a high risk for bleeding in general, you would definitely be considered high risk during pregnancy. Your risk is not only at delivery (which could ideally be in a controlled environment where they could CLOSELY monitor you) but also at other points in the pregnancy.
You have a history of ruptured varacies, so I would think that with the increased blood volume that accompanies pregnancy, your vessels would be at an even higher risk for rupture.
People with unique medical issues get pregnant everyday, but I would definitely make an appointment with the gastro and the OBGYN before trying to get pregnant to make sure that you will be able to carry a baby to term without endangering you or the baby. Also, they may want to start making medication changes before you get pregnant to avoid complications that could arise with the fetus very early in pregnancy.
I truly wish you the best of luck!!
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