A case series of Budd-Chiari syndrome in pregnancy undergoing elective caesarean section: Anaesthetic considerations

Budd–Chiari syndrome (BCS) is an uncommon disorder caused by hepatic venous outflow obstruction leading to hepatomegaly, ascites, and abdominal pain. The condition poses significant challenges during pregnancy due to altered hepatic function, hypercoagulability, and increased haemodynamic demands. We present a series of three pregnant patients with known BCS scheduled for elective lower segment caesarean section, each managed using a multidisciplinary approach. All patients were on anticoagulation therapy during pregnancy and underwent careful preoperative assessment with haematology, gastroenterology, and obstetric consultations. Anticoagulants were discontinued 24 hours before surgery. Two patients received spinal anaesthesia, while one underwent general anaesthesia due to coagulopathy (international normalised ratio 1.6). Estimated intraoperative blood loss ranged from 800 to 1000 ml. All patients remained haemodynamically stable throughout the procedure and the postoperative period. Anticoagulation was resumed within 12–24 hours postoperatively, and no maternal or neonatal complications were reported. Pregnancy complicated by BCS requires vigilant planning and individualised anaesthetic management. A multidisciplinary approach, appropriate timing of anticoagulation discontinuation, and careful intraoperative monitoring are crucial to optimise maternal and foetal outcomes. Elective caesarean delivery in a tertiary care setting with close coordination between obstetrician, anaesthesiologist, haematology, and hepatology teams can significantly improve prognosis in women with BCS.