Talk: Pregnancy, Periods And Protection


Dr Alison De Maio

NCHD to Dr. B. Byrne

Consultant Obstetrician
Coombe Hospital Dublin


  • HPV is a group of viruses linked to cervical cancer and genital warts

  • All sexually active women are exposed to the virus

  • Vaccination NOT LIVE and therefore safe for impaired immune systems and very much recommended

  • HSE have a school programme

  • Annual screening for individuals with impaired immune systems starting at the age of 20 due to increased risk of getting the virus


  • Consult your Doctor

  • The pill: not suitable in most liver diseases

  • progesterone only pill: more suitable due to no oestrogen

  • Depo Provera: progesterone only injection – suitable for most but avoid for active Liver Disease

  • Implanon: progesterone only implant – lasts 3 years – suitable for most but avoid for active Liver Disease

  • Intrauterine devices (eg Mierena coil/ Copper coil): suitable for those with liver disease but not with Wilsons Disease

  • Condoms: safe and encouraged to prevent STIs

  • Contraception as a subject is very important and needs to be discussed as pregnancy has serious implications for Liver Disease



  • Before conception consult your doctor

  • Liver disorders are not a reason to avoid pregnancy.

  • Not at increased risk but implications and effects are more severe


Severe Cirrhosis and pregnancy

  • Inform obstetrician to carefully plan pregnancy

  • Difficulty conceiving

  • Increase risks of preterm delivery, miscarriage, stillbirth and maternal death

  • Risk of liver failure

Portal Hypertension and pregnancy

  • Increased risk of bleeding from esophageal varices

  • Advise endoscopy for women with cirrhosis prior to pregnancy

  • May consider medications

Post Liver Transplant and pregnancy

  • shows good outcomes

  • decrease risk miscarriage and increase rate of live births vs general population

  • most women resume normal periods within 7 months

  • Conception should be postponed at least 12 months after transplant due to impaired immunity

Pre conception for all Liver Disorders

  • Preconception counseling is advised with obstetric and liver teams

  • Vaccinations should be up to date

Medications and Pregnancy

  • Majority of meds continued with pregnancy but doses may change

  • CellCept (mycophenolate mofetil) is to be avoided in pregnancy

  • Breastfeeding on medication is OK for the most part – consult doctor


High Risk Pregnancy

  • Coombe has a high-risk clinic that someone will be referred to.

  • Closely monitor blood pressure, transplant function and baby’s growth

  • Aim for normal delivery on collaboration with transplant physician and neonatologist

Concluding recommendations

  • Get HPV vaccination

  • Use appropriate contraception and condoms

  • Link in with the Coombe before pregnancy prior pregnancy