Case report We present a 29-year-old lady with a history of a 27 week stillbirth (secondary to placental insufficiency) after which she developed a deep vein thrombosis and pulmonary embolism. She then had three recurrent early miscarriages followed by another pregnancy which ended as a forceps delivery at term. She developed another pulmonary embolism during this pregnancy notwithstanding prophylactic low molecular weight heparin and was treated until six weeks postpartum.

She had a negative thrombophilia screen and negative anticardiolipin antibodies but a persistent mild thrombocytopenia. Her BMI was 45.

She fell pregnant again ten months after her previous delivery. In view of her significant risks, she was started on 24000 Units of tinzaparin daily prophylactically. She presented with upper abdominal pain at 20 weeks gestation with abnormal liver function tests. A scan and magnetic resonance cholangiopancreatography revealed non-cirrhotic portal hypertension (NCPH) secondary to extra-hepatic portal vein thrombosis and splenomegaly. She continued on tinzaparin which was increased to a twice-daily dose, titrated according to anti-Xa levels and was induced at 38 weeks, had a normal delivery but suffered a major postpartum haemorrhage (secondary to a retained placenta).

Pregnancy in patients with NCPH is exceedingly rare leading to an absence of guidelines on its management.1 Multidisciplinary involvement is imperative.