1
|
Loza H, Carrión G, Haro A, Loza F. Hepatic Rupture Associated With HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets) Syndrome: A Report of Two Cases and Literature Review. Cureus 2024; 16:e56627. [PMID: 38650805 PMCID: PMC11034703 DOI: 10.7759/cureus.56627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
Hepatic rupture is a rare complication of severe preeclampsia. A high index of suspicion is required in the presence of abdominal pain accompanied by hemodynamic decompensation in a pregnant woman. Hepatic rupture constitutes a medical emergency that demands immediate intervention, often with the support of other medical disciplines, in a highly specialized hospital setting. Unruptured hepatic hematomas can be managed conservatively. Immediate delivery and surgical repair of the liver are necessary for maternal survival. Spontaneous liver rupture in pregnancy is often unrecognized, highly lethal, and not completely understood with few cases having been reported in the literature. Therefore, we present two cases of HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome with hepatic rupture, emphasizing their clinical presentation and therapeutic approaches.
Collapse
Affiliation(s)
- Homero Loza
- Obstetrics and Gynecology, Hospital de los Valles, Quito, ECU
| | - Gabriela Carrión
- Obstetrics and Gynecology, Hospital General Dr. Enrique Ortega Moreira, Guayaquil, ECU
- Obstetrics and Gynecology, Universidad Espíritu Santo (UEES) Clinic, Guayaquil, ECU
| | - Alexis Haro
- Obstetrics and Gynecology, Universidad Internacional del Ecuador, Quito, ECU
- Obstetrics and Gynecology, Axxis Hospital, Quito, ECU
| | - Felipe Loza
- Obstetrics and Gynecology, Universidad Internacional del Ecuador, Quito, ECU
| |
Collapse
|
2
|
Villart A, Burban P, Mosnino E, Derouich M. Subcapsular liver hematoma complicating HELLP syndrome: A case report and review of management strategies. Case Rep Womens Health 2023; 40:e00561. [PMID: 37954515 PMCID: PMC10637892 DOI: 10.1016/j.crwh.2023.e00561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023] Open
Abstract
Subcapsular liver hematoma is a life-threatening complication of pregnancy. It is associated with preeclampsia and HELLP syndrome. We present the case of a 36-year-old Caucasian nulliparous woman who was diagnosed at 29 weeks and 6 days of gestation with mild preeclampsia. After brief hospitalization she was discharged. During a daily follow-up, at 31 weeks and 3 days of gestation, she complained of mild abdominal pain and blood tests revealed HELLP syndrome. The cervix was unripe. A healthy baby was delivered by emergency cesarean section. The following day, the patient complained of persistent abdominal pain, and at the same time the hepatic cytolysis worsened dramatically. A computed tomography (CT) scan revealed a significant subcapsular hematoma without any active bleeding or breach of Glisson's capsule. We treated the patient conservatively and she was discharged home 10 days after the diagnosis was made. The symptoms of subcapsular liver hematoma are non-specific. They include nausea, vomiting and epigastric pain, and pain in the right upper quadrant or shoulder. Biological analyses can show hepatic cytolysis, haemolysis and coagulation disorders. Medical imaging can confirm the diagnosis. The management of subscapular liver hematoma may depends on whether there is hemodynamic stability, active bleeding or breach of Glisson capsule's. If the patient is stable and in the absence of active bleeding, management should be purely symptomatic.
Collapse
Affiliation(s)
- Agnès Villart
- Department of Gynecology and Obstetrics, Argenteuil Hospital, 69 Rue du Lieutenant Colonel Prudhon, 95107 Argenteuil, France
| | - Pauline Burban
- Department of Gynecology and Obstetrics, Argenteuil Hospital, 69 Rue du Lieutenant Colonel Prudhon, 95107 Argenteuil, France
| | - Elie Mosnino
- Department of Gynecology and Obstetrics, Argenteuil Hospital, 69 Rue du Lieutenant Colonel Prudhon, 95107 Argenteuil, France
| | - Mohamed Derouich
- Department of Gynecology and Obstetrics, Argenteuil Hospital, 69 Rue du Lieutenant Colonel Prudhon, 95107 Argenteuil, France
| |
Collapse
|
3
|
García González LA, Rodríguez Uría R, Noriega Menendez P, Solar Garcia L, Miyar de León A, González-Pinto Arrillaga IM, Granero Trancón JE. Ruptured subcapsular liver hematoma as a rare complication of HELLP syndrome. A therapeutic challenge. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:465-466. [PMID: 36426863 DOI: 10.17235/reed.2022.9276/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
HELLP syndrome (HS), a low-incidence condition of uncertain pathogenesis associated with pregnancy hypertensive syndromes, is characterized by hemolysis, elevated liver enzymes and low platelet count. Ruptured subcapsular liver hematoma complicated with hemoperitoneum is an uncommon but very serious condition where early recognition and multidisciplinary management are key to reduce its associated maternal, infant mortality rate. Symptoms are nonspecific, characterized by por epigastric pain, nausea and vomiting; clinical suspicion and appropriate imaging studies are of crucial importance. We report the case of a 36-year-old primiparous woman at 39 weeks of gestation. She was admitted for early membrane rupture, with delivery complicated by retained placenta. During the immediate puerperium she had blood pressure > 140/90 mmHg, epigastric pain and vomiting, which required respiratory and hemodynamic support. An exploratory laparotomy was performed that revealed a massive hemoperitoneum as well as CR in the RLL with multifocal active bleeding. The left liver lobe was macroscopically normal. The patient underwent hemoperitoneum drainage and hepatic packing (HP); biopsy findings were consistent with necrosis. Polytransfusion was initiated with blood products and antihemorrhagic agents.
Collapse
Affiliation(s)
| | - Raquel Rodríguez Uría
- Cirugía General y Aparato Digestivo, Hospital Universitario Central de Asturias , España
| | | | | | | | | | | |
Collapse
|
4
|
Liu J, Liu L, Liao G, Yao L. Conservative Treatment of Huge Hepatic Subcapsular Hematoma Complicated with Hepatic Infarction after Cesarean Section Caused by HELLP Syndrome - a Case Report and Literature Review. Z Geburtshilfe Neonatol 2023. [PMID: 36849111 DOI: 10.1055/a-1967-2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Hepatic subcapsular hematoma and hepatic infarction in labor are mostly secondary to HELLP syndrome and preeclampsia. There are few reported cases with a complicated diagnosis and treatment and high mortality. Here, we present a case of a huge hepatic subcapsular hematoma complicated with hepatic infarction after cesarean section that was secondary to HELLP syndrome and the patient was treated conservatively. Further, we have discussed the diagnosis and treatment of hepatic subcapsular hematoma and hepatic infarction caused by HELLP syndrome.
Collapse
Affiliation(s)
- Jun Liu
- Department of Obstetrics, Pingxiang Maternal and Child Health Hospital, Pingxiang, China
| | - Li Liu
- Department of Gynecology, Clinical Oncology School of Fujian Medical University,Fujian Cancer Hospital, Fuzhou, China
| | - Guangyuan Liao
- Department of Intensive Care Unit, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lifeng Yao
- Department of Obstetrics, Pingxiang Maternal and Child Health Hospital, Pingxiang, China
| |
Collapse
|
5
|
Tegene D, Regassa G, Usu A, Ayalew N. Successful Management of Intraoperatively Diagnosed Ruptured Spontaneous Sub-Capsular Liver Hematoma in a Woman with Preeclampsia. Int J Womens Health 2021; 13:1175-1179. [PMID: 34876860 PMCID: PMC8643198 DOI: 10.2147/ijwh.s333905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022] Open
Abstract
Background Ruptured subcapsular hematoma of the liver is one of the rare life-threatening complications of pregnancy and its incidence varies between 1/45,000 and 1/225,000 births. Case Presentation A 32-year-old woman who claimed 9 months amenorrhea, presented to our hospital with elevated blood pressure and pushing down pain. After evaluation she was admitted to the labor ward with a diagnosis of latent first stage of labor and preeclampsia with severe features. She gave birth by outlet vacuum. Immediately following delivery she developed hypotension with signs of intra-abdominal fluid collection. Surgical exploration revealed massive hemoperitoneum with ruptured subcapsular hepatic hematoma. She was managed conservatively with pressure packing and drainage tube. The patient improved and was discharged after 12 days of hospital stay. Conclusion Timely surgical intervention, multidisciplinary team, on-time availability of blood products, and proper postoperative follow up are crucial to optimize the patient outcome.
Collapse
Affiliation(s)
- Dereje Tegene
- Department of Obstetrics and Gynecology, Adama Hospital Medical College, Adama, Ethiopia
| | - Getahun Regassa
- Department of Obstetrics and Gynecology, Adama Hospital Medical College, Adama, Ethiopia
| | - Aman Usu
- Department of Obstetrics and Gynecology, Adama Hospital Medical College, Adama, Ethiopia
| | - Netsanet Ayalew
- Department of Obstetrics and Gynecology, Adama Hospital Medical College, Adama, Ethiopia
| |
Collapse
|
6
|
Varlas VN, Bohîlțea R, Gheorghe G, Bostan G, Angelescu GA, Penes ON, Bors RG, Cloțea E, Bacalbasa N, Diaconu CC. State of the Art in Hepatic Dysfunction in Pregnancy. Healthcare (Basel) 2021; 9:1481. [PMID: 34828527 PMCID: PMC8618725 DOI: 10.3390/healthcare9111481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 12/21/2022] Open
Abstract
Hepatic dysfunction in pregnant women is always challenging for the obstetrician, as the spectrum of hepatic abnormalities can be very large and have various implications, both for mother and fetus. There is a diagnostic and therapeutic polymorphism of hepatic dysfunction in pregnancy and insufficient knowledge related to the etiopathogenesis and epidemiology of this disease. The clinical forms of hepatic dysfunction encountered in pregnancy can vary from liver diseases related to pregnancy (e.g., HELLP syndrome, intrahepatic cholestasis, hyperemesis gravidarum, or acute fatty liver of pregnancy) to de novo ones occurring in pregnancy, and pre-existing liver disease (cholelithiasis, Budd-Chiari syndrome, and cirrhosis). We performed a systematic literature search over 10 years. The review protocol assumed a search of two databases (PubMed®/MEDLINE and Web of Science Core Collection). The strategy regarding the management of these diseases involves multidisciplinary teams composed of different specialists (obstetricians, gastroenterologists and anesthetists) from specialized tertiary centers. Despite the improving prognosis of pregnant women with liver diseases, the risk of maternal-fetal complications remains very high. Therefore, it is necessary to ensure careful monitoring by a multidisciplinary team and to inform the patients of the potential risks.
Collapse
Affiliation(s)
- Valentin Nicolae Varlas
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (V.N.V.); (R.G.B.); (E.C.)
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
| | - Roxana Bohîlțea
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (V.N.V.); (R.G.B.); (E.C.)
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
| | - Gina Gheorghe
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Georgiana Bostan
- Department of Obstetrics and Gynecology, County Emergency Hospital “St. John the New”, 720034 Suceava, Romania;
| | - Gabriela Anca Angelescu
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
- Department of Internal Medicine, County Emergency Hospital Ilfov, 022115 Bucharest, Romania
| | - Ovidiu Nicolae Penes
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
- Department of Anesthesiology and Intensive Care, University Clinical Hospital, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Roxana Georgiana Bors
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (V.N.V.); (R.G.B.); (E.C.)
| | - Eliza Cloțea
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania; (V.N.V.); (R.G.B.); (E.C.)
| | - Nicolae Bacalbasa
- “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.A.A.); (O.N.P.); (N.B.)
- Department of Visceral Surgery, “Fundeni” Clinical Institute, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| |
Collapse
|
7
|
Brito M, Gamito M, Neves AR, Caeiro F, Martins A, Dias E, Veríssimo C. Conservative management of a pregnancy complicated by preeclampsia and postpartum spontaneous hepatic rupture: A case report and review of the literature. Eur J Obstet Gynecol Reprod Biol 2021; 267:79-89. [PMID: 34731641 DOI: 10.1016/j.ejogrb.2021.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/12/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Most spontaneous hepatic rupture cases are associated with a pregnancy-induced hypertensive disorder like preeclampsia and HELLP syndrome. Although it is a rare complication, it is still associated with high maternal and fetal morbidity and mortality rates. With this study, we aim to present a case report and review the available literature on hepatic rupture associated with hypertensive disorders of the pregnancy. METHODS We present a case report and a review of the literature of the last 20 years on hepatic rupture associated with pregnancy-induced hypertensive disorders. The selected cases were reviewed to collect information on maternal characteristics, clinical presentation, diagnostic studies, therapeutic modalities and maternal and fetal outcomes. RESULTS Our review has found 57 publications describing a total of 93 cases of hepatic hemorrhage with capsule rupture associated with pregnancy-induced hypertensive disorders. Most of the patients were less than 35 years old and primiparous and the first symptoms of hepatic rupture included epigastric and right upper abdominal pain. Most of the diagnoses were made during surgery without previous diagnosis and, in the majority of cases, a surgical approach was necessary to achieve hemostasis. Perihepatic packing was the most used surgical method. DISCUSSION/CONCLUSION Our clinical case and literature review reinforces the importance of closely monitoring all pregnancies complicated with hypertensive disorders, including in the postpartum period. Although hepatic rupture accounts for high maternal and fetal morbidity and mortality rates, it is possible to keep a conservative approach with good maternal and fetal outcomes, with a high index of suspicious, an early diagnosis and a multidisciplinary approach.
Collapse
Affiliation(s)
- Marta Brito
- Department of Obstetrics and Gynecology at Centro Hospitalar, Universitário Lisboa Central, Maternidade Dr. Alfredo da Costa, Rua Viriato 1 2890-495, Lisbon, Portugal.
| | - Mariana Gamito
- Department of Obstetrics and Gynecology at Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514 Loures, Portugal
| | - Ana Raquel Neves
- Department of Medicine Reproduction, Hospital Universitário Dexeus e Universidade Autónoma de Barcelona, Carrer de Sabino Arana, 5, 19, 08028 Barcelona, Spain
| | - Filipa Caeiro
- Department of Obstetrics and Gynecology at Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514 Loures, Portugal
| | - Amália Martins
- Department of Obstetrics and Gynecology at Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514 Loures, Portugal
| | - Elsa Dias
- Department of Obstetrics and Gynecology at Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514 Loures, Portugal
| | - Carlos Veríssimo
- Department of Obstetrics and Gynecology at Hospital Beatriz Ângelo, Av. Carlos Teixeira 3, 2674-514 Loures, Portugal
| |
Collapse
|
8
|
"Hepatic rupture in preeclampsia and HELLP syndrome: A catastrophic presentation". Taiwan J Obstet Gynecol 2021; 59:643-651. [PMID: 32917311 DOI: 10.1016/j.tjog.2020.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 11/24/2022] Open
Abstract
The objective of index study is to review the available literature on hepatic rupture or hematoma in hypertensive disorders of pregnancy to find the incidence, associated risk factors, clinical presentation, mode of management and feto-maternal outcome. Electronic database was searched using hepatic rupture or hematoma in pregnancy, preeclampsia, eclampsia, and HELLP syndrome (Hemolysis, EL: elevated liver enzymes, LP: low platelet count) as key words and literature published since January, 2000 to December, 2018 which met the inclusion criteria was reviewed. A total of 56 articles were reviewed describing 93 cases of hepatic hemorrhage in hypertensive disorders of pregnancy. Treatment varied from conservative management to abdominal packing, hepatic artery embolization, and partial hepatectomy to liver transplantation. Seven out of 93 patients with liver rupture met mortality and in one of them diagnosis was established on autopsy. Unawareness of the hepatic rupture in pregnancy by an obstetrician demands high index of suspicion for diagnosis and requires specialized, focused and exhaustive management for optimal feto-maternal outcome. Laparotomy and perihepatic packing is a viable option in patients with unstable vitals and is feasible even in limited resource settings.Short interval between diagnosis and management may enhance the feto-maternal survival rate and prevent further morbidity or mortality.
Collapse
|
9
|
Ruptured Subcapsular Liver Hematoma: A Rare Complication of HELLP Syndrome. Case Reports Hepatol 2020; 2020:8836329. [PMID: 33014483 PMCID: PMC7516696 DOI: 10.1155/2020/8836329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022] Open
Abstract
Subcapsular liver hematoma (SLH) is a rare complication of HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. We report a previously healthy 16-year-old female presenting with pre-eclampsia requiring emergent C-section, who developed immediate postoperative bleeding and abdominal distention. Abdominal computed tomography angiography (CTA) revealed a large encapsulated liver hematoma with active extravasation. The patient was successfully treated with a multidisciplinary approach with medical and surgical management.
Collapse
|
10
|
Bradke D, Tran A, Ambarus T, Nazir M, Markowski M, Juusela A. Grade III subcapsular liver hematoma secondary to HELLP syndrome: A case report of conservative management. Case Rep Womens Health 2019; 25:e00169. [PMID: 31908974 PMCID: PMC6940712 DOI: 10.1016/j.crwh.2019.e00169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 12/27/2022] Open
Abstract
Subcapsular liver hematoma (SLH) is a rare condition that is associated with preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. A high level of suspicion, early diagnosis, and coordinated, intensive multidisciplinary management are necessary to monitor for serious complications and prevent death. Options include conservative management, hepatic resection, hepatic artery ligation and liver transplantation. This paper describes a 34-year-old woman with HELLP syndrome who developed a large grade III SLH that was managed conservatively.
Collapse
Affiliation(s)
- Daniel Bradke
- Department of Obstetrics and Gynecology, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey, United States of America
| | - Ashley Tran
- Rutger's University New Jersey Medical School, Newark, New Jersey, United States of America
| | - Tatiana Ambarus
- Department of Obstetrics and Gynecology, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey, United States of America
| | - Munir Nazir
- Department of Obstetrics and Gynecology, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey, United States of America
| | - Maryann Markowski
- Department of Obstetrics and Gynecology, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey, United States of America
| | - Alexander Juusela
- Department of Obstetrics and Gynecology, RWJ Barnabas Health, Newark Beth Israel Medical Center, Newark, New Jersey, United States of America
| |
Collapse
|
11
|
Abstract
In cases of preeclampsia with severe features and hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome, hepatic complications portend significant short-term and long-term maternal health implications. In this section, we will discuss the physiology of normal hepatic function in pregnancy, the pathophysiology of the abnormalities noted in hepatic function during the process of preeclampsia development, the diagnosis and management of preeclampsia, imitators of HELLP syndrome, the utility of various biomarkers in the diagnosis and prognosis of the preeclampsia disease spectrum, possible underlying genetic factors predisposing women to developing hepatic abnormalities with preeclampsia, and finally prognosis and management of a subcapsular hematoma.
Collapse
|
12
|
Alese MO, Moodley J, Naicker T. Preeclampsia and HELLP syndrome, the role of the liver. J Matern Fetal Neonatal Med 2019; 34:117-123. [PMID: 30704316 DOI: 10.1080/14767058.2019.1572737] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Preeclampsia is a multisystemic disorder which accounts for the high prevalence of maternal and perinatal morbidity and mortality, especially in middle and low-income countries. Currently, the primary intervention is the urgent delivery of the fetus, hence it would be advantageous to identify those who are likely to develop preeclampsia and the maternal and fetal outcomes. However, an array of risk factors makes these challenging. This review explores the potentials of liver biomarkers in predicting the occurrence and outcome of preeclampsia, which could be beneficial in reducing the burden of the disease. Liver dysfunction in preeclampsia results in a severe condition, hence liver function tests are specific predictors of outcome.
Collapse
Affiliation(s)
- Margaret Olutayo Alese
- Optics and Imaging Center, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Thajasvarie Naicker
- Optics and Imaging Center, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
13
|
Abstract
Subcapsular liver hematoma is a rare but potentially life-threatening complication of preeclampsia and hemolysis, elevated liver enzymes, and low platelets syndrome. It may present with nonspecific signs and symptoms, none of which are diagnostic, and can mimic pulmonary embolism of cholecystitis. There is no consensus on the management of subcapsular liver hematoma. Unruptured liver hematoma can be conservatively managed. When rupture occurs, surgical, endovascular approaches and, rarely, liver transplantation, may be required. Actual literature is scant and retrospective in nature. Data on follow-up, time to resolution and outcome of subsequent pregnancies are very limited. We here review the diagnosis and management of liver hematoma.
Collapse
|
14
|
Right hepatectomy after spontaneous hepatic rupture in a patient with preeclampsia: A case report. Int J Surg Case Rep 2017; 39:250-252. [PMID: 28863378 PMCID: PMC5577397 DOI: 10.1016/j.ijscr.2017.07.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/29/2017] [Accepted: 07/30/2017] [Indexed: 11/27/2022] Open
Abstract
Spontaneous hepatic rupture is a rare complication of preeclampsia and HELLP syndrome. It carries a high maternal and perinatal mortality. Multidisciplinary management is key to optimal outcomes. Usual management includes perihepatic packing or angioembolization but formal lobectomy may be required in special cases.
Introduction Spontaneous hepatic rupture associated with preecalmpsia or HELLP syndrome is a rare and life threatining event, only 200 cases have been reported in the literature. Presentation of case We present a case of a 31 year old female with 28 weeks of gestation that presented with acute abdominal pain, elevated blood pressure and altered liver enzymes an abdominal ultrasound that showed a subcapsular hematoma occupying the whole right lobe and free abdominal fluid, she required emergent laparotomy, C-section, hepatic packing, followed by angioembolization and finally right hepatectomy. Discussion and conslusion Spontaneous hepatic rupture due to preeclampsia or HELLP syndrome is a medical emergency, it requires a prompt and decisive treatment. Multiple treatment modalities are available, from simple hepatic packing to endovascular embolization, but in extreme situations a formal hepatectomy might be required.
Collapse
|