Maternal-Fetal Complications of Pregnancy Complicated by Cirrhosis at the Kara University Hospital Center (CHU Kara)

Abstract

Introduction: the occurrence of pregnancy in a woman with cirrhosis represents a major medical challenge, owing both to the potential complications and to the often limited access to specialized care within the African context. Objective: to describe the various maternal and fetal complications, as well as the avenues for improving the management of cirrhosis during pregnancy. Method: a case series of pregnancies complicated by cirrhosis was conducted at the Kara University Hospital Centre (CHU Kara) over a three-year period (January 2022-December 2024). Results: twenty cases of singleton pregnancies complicated by cirrhosis were recorded. The mean age of the pregnant women was 29.9 years, ranging from 22 to 44 years. Among them, 15 were multigravid and 16 were multiparous. One pregnant woman had pre-existing hypertension, and 11 had a history of untreated hepatitis B infection. Twelve women had a gestational age between 15 and 28 weeks of amenorrhea (WA). The functional symptoms observed included asthenia and pallor (60%), as well as abdominal pain (50%). Ascites was present in all patients (100%), clinical anemia in 70%, and splenomegaly in 40%. Elevated liver enzymes were observed in all pregnant women (100%), while anemia was noted in 80%, hypoglycemia in 70%, and hyperkaliemia in 60%. The main etiology of cirrhosis was hepatitis B (80%). The various maternal-fetal complications included ascitic decompensation (100%), hepatic encephalopathy (40%), renal failure (45%), hepatocellular carcinoma (30%), and prematurity (20%). Management was symptomatic and focused on treating complications, with medical termination of pregnancy performed in eight patients. There were 12 cases of maternal death and six stillbirths. Conclusion: the management of cirrhosis during pregnancy remains a major challenge in our country, which has a high prevalence of hepatitis B, resulting in delayed diagnosis and catastrophic maternal-fetal complications. This underscores the importance of prevention, as well as the early diagnosis and treatment of chronic liver diseases.