Planned preoperative plasma exchange for cesarean delivery in a pregnant woman with Child–Pugh class C cirrhosis: a case report and literature review

Abstract Background Pregnancy complicated by Child–Pugh class C cirrhosis is rare and poses major challenges because correction of severe coagulopathy may worsen fluid overload. Case presentation A 40-year-old pregnant woman with cirrhosis suspected to be secondary to autoimmune hepatitis developed severe hypofibrinogenemia, thrombocytopenia, and marked fluid overload. Her liver disease progressed to Child–Pugh class C, and planned cesarean delivery was scheduled at 26 weeks and 6 days of gestation. Plasma exchange using fresh frozen plasma was performed once daily for 3 consecutive days before surgery, together with albumin, diuretics, and targeted coagulation factor replacement. Cesarean delivery was completed despite an estimated blood loss of 3,650 mL. The patient was extubated in the operating room and discharged home on postoperative day 15. The infant was discharged home on postnatal day 122 and subsequently showed generally appropriate growth and neurodevelopment. Conclusion Planned preoperative plasma exchange may be a useful bridge to controlled delivery in selected pregnancies complicated by severe decompensated cirrhosis.