Gynecology 2027

Background: Pregnancy in cirrhosis is uncommon and carries substantial maternal and perinatal risk, chiefly from portal hypertension. Saudi tertiary-centre data are scarce.

Objective: To describe the characteristics, management, and maternal and fetal outcomes of pregnant women with cirrhosis at a tertiary centre in Riyadh.

Methods: We retrospectively reviewed pregnant women with cirrhosis managed at King Faisal Specialist Hospital and Research Centre, Riyadh (January 2020–September 2026) . Cirrhosis was diagnosed by histology and/or characteristic imaging with supportive laboratory findings. Data were extracted from medical records and summarised descriptively as median (range) or n (%).

Results: Four women (four pregnancies) were included: median age 29 years (range 26–41). Aetiology was autoimmune hepatitis (n=2), cryptogenic cirrhosis (n=1), and congenital hepatic fibrosis (n=1); MELD/MELD-Na was 7–12. Three had oesophageal varices, all previously banded (two after variceal haemorrhage); two had portal vein thrombosis, all had thrombocytopenia, and two had diabetes. None had band ligation during pregnancy. One pregnancy ended in missed miscarriage at 6 weeks (dilation and curettage with transfusion). Three women delivered live infants at a median of 36+1 weeks (range 35+5–36+3): one by emergency caesarean, one by elective repeat caesarean, and one vaginally after admission for induction. The emergency caesarean was complicated by variceal haemorrhage requiring oesophageal stent placement, intensive care, and multiple blood products; the repeat caesarean was uncomplicated, and postpartum jaundice followed the vaginal delivery. Three of four women (75%) received blood products; there were no maternal deaths. Median birth weight was 2.47 kg (range 2.36–4.22); 5-minute Apgar scores were 7–9; two of three infants (67%) required neonatal intensive care. One woman underwent living-donor liver transplantation 13 months after delivery.

Conclusion: All pregnancies beyond the first trimester ended in live late-preterm births without maternal death, but morbidity was considerable, including life-threatening variceal haemorrhage and frequent transfusion. Individualised risk assessment, antenatal variceal surveillance, optimisation of comorbidities, and multidisciplinary delivery planning are essential.The small, heterogeneous sample limits generalisability and precludes firm conclusions regarding predictors of adverse outcomes; larger prospective studies are needed.

Dr. Maryam Ashraf Ali is affiliated with Alfaisal University and King Faisal Specialist Hospital & Research Centre (KFSHRC), Saudi Arabia. Her academic and clinical interests include maternal and fetal health, high-risk pregnancy management, and complex obstetric conditions. Her research focuses on maternal and fetal outcomes in pregnant women with liver cirrhosis, drawing on clinical experience from a tertiary referral centre in Riyadh, Saudi Arabia. Through her research, she aims to contribute to improving obstetric care and pregnancy outcomes in women with complex medical conditions.