Clinical Study Of The Effect Of Budd - Chiari Syndrome On Pregnancy And The Systematic Review Of Complicated Hepatocellular Carcinoma

Background&Aim: Data regarding influence of unrecognized Budd-Chiari syndrome(BCS) on fertility and pregnancy outcomes are extremely limited. This study wasundertaken to assess the obstetric outcomes in Chinese BCS women.Methods: We performed a retrospective analysis of obstetric history in46marriedwomen with BCS in a single center between July1999and April2013.Results: Of46women,82.6%(38/46) had a history of infertility after the onset of BCS.There were19.6%(9/46) with primary and63.0%(29/46) with secondary infertility.105pregnancies occurred in37women. The rate of spontaneous abortions, stillbirths,induced abortions and live births were33.3%(35/105),15.2%(16/105),4.8%(5/105)and46.7%(49/105), respectively. Neonatal deaths occurred in14.3%(7/49) of the livebirths. The mean number of pregnancies and children per individual was2.28(105/46)and0.91(42/46), respectively. After treatment, of11(11/38,28.9%) infertile women whowere aged small than45years and tried to conceive,7had pregnancies-5had5live births,1had an induced abortion at40days’ gestation,1had a spontaneous abortion at2months’ gestation. The infertility rate dropped significantly from82.6%(38/46) to36.4%(4/11).Conclusions: BCS may induce infertility and poor pregnancy outcomes. After wellcontrolled of BCS, infertile women could have improved pregnancy outcome. However,most of the patients had missed their child-bearing age, which suggests that routinelyprecluding BCS should be warranted in patients with unexplained infertility. Part two. Prevalence and risk factors of hepatocellularcarcinoma in Budd-Chiari syndrome: a systematicreviewBackground&Aim: Budd-Chiari syndrome (BCS) can be incidentally complicated byhepatocellular carcinoma (HCC), thereby decreasing the survival of these patients. Ourstudy aims to systematically review the prevalence and risk factors of HCC in BCSpatients.Methods: A PubMed search was performed to identify all original articles that reportedthe prevalence and risk factors of HCC in BCS patients. Primary items were theprevalence and risk factors of HCC in BCS patients.Results: Of1487articles identified,16were included in our study. The prevalence ofHCC in BCS is2.0-46.2%in12Asian studies,40.0-51.6%in two African studies,11.3%in one European study, and11.1%in one American study. Irrespective of hepatitis as the underlying risk factor of HCC, the pooled prevalence of HCC was17.6%in BCS patients[95%confidence interval (CI):10.1-26.7%],26.5%in inferior vena cava obstruction(95%CI:14.4-40.7%), and4.2%in hepatic vein obstruction (95%CI:1.6-7.8%). Aspatients with HCC and concomitant hepatitis were excluded, the pooled prevalence ofHCC was15.4%in BCS patients (95%CI:6.8-26.7%). Heterogeneity among studies wasstatistically significant in these meta-analyses. The risk factors of HCC in BCS includedhepatic venous pressure gradient and female sex in two Asian studies, and male sex,factor V Leiden mutation, and inferior vena cava obstruction in one European study.Conclusion: HCC was frequent in BCS. However, there was a huge variation amongstudies. Routine surveillance for HCC is warranted in BCS patients. The risk factors ofHCC in BCS may vary depending on the geographic origin of the studies.