J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

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Case Report

Volume 000, Number 000, May 2026, pages 000-000

Pregnancy After In Vitro Fertilization in Budd–Chiari Syndrome Secondary to Polycythemia Vera: Multidisciplinary Management and Perioperative Considerations

Table

↓ **Table 1.** Chronological Clinical Course Summarizing Key Events, Findings, and Management Decisions From Pre-Conception to Postpartum
Time period/gestational age	Clinical event	Key findings	Management/interventions
AFP: alpha-fetoprotein; BCS: Budd–Chiari syndrome; ICP: intrahepatic cholestasis of pregnancy; IVF: in vitro fertilization; LMWH: low-molecular-weight heparin; MELD: Model for End-Stage Liver Disease; MRI: magnetic resonance imaging; OHSS: ovarian hyperstimulation syndrome; PV: polycythemia vera; UDCA: ursodeoxycholic acid.
Pre-conception period	Known Budd–Chiari syndrome and polycythemia vera	Chronic hepatic venous outflow obstruction	Long-term anticoagulation; hepatology and hematology follow-up
Early pregnancy (post-IVF conception)	IVF pregnancy complicated by OHSS	Ascites	LMWH; monitoring
Third trimester	Progression to severe ICP and portal hypertension; Decision for planned early delivery	Elevated bile acids; rising bilirubin; thrombocytopenia	UDCA therapy; Intensified surveillance; multidisciplinary decision for preterm cesarean section
Delivery	Preterm cesarean section	High maternal risk due to BCS, PV, severe ICP, portal hypertension	Perioperative terlipressin; regional anesthesia; close monitoring
Immediate postpartum period	Uncomplicated recovery	No hemorrhagic or thrombotic events	Continuation of LMWH; standard postpartum care
Postpartum follow-up	Long-term hepatic evaluation	MRI: cirrhotic-pattern changes; MELD 15; mildly elevated AFP	Hepatology follow-up; ongoing surveillance