Pregnancy complicated by systemic lupus erythematosus, autoimmune hepatitis and portal hypertension

Introduction: Pregnancy in women with concurrent systemic lupus erythematosus (SLE), autoimmune hepatitis and portal hypertension is exceptionally rare, with fewer than 10 reported cases of any two conditions together and none describing the full triad with detailed haemostatic assessment. Case description: /l) throughout pregnancy. Second-trimester endoscopy showed grade I varices without red signs. Planned caesarean section was performed at 34-35 weeks after foetal lung maturation, delivering a female neonate weighing 2,270 g with Apgar scores 8/9. Maternal and neonatal outcomes were favourable. Conclusion: Favourable outcomes are achievable despite the concurrent burden of SLE, autoimmune hepatitis (AIH) and portal hypertension in pregnancy. Key points include interpreting thrombocytopenia as a multifactorial sign, balancing bleeding and thrombosis risks, and delivering individualised multidisciplinary care. LEARNING POINTS: /l without bleeding may allow expectant management rather than intervention.The bleeding-thrombosis paradox requires balancing prothrombotic tendencies (pregnancy, SLE) against bleeding risks (portal hypertension, varices, and thrombocytopenia). Low-dose aspirin may be used cautiously; low molecular weight heparin is not mandatory in antiphospholipid antibody-negative patients with significant bleeding risk.