Pre-eclampsia/eclampsia and hepatic rupture

• Published in: International journal of gynecology and obstetrics Vol. 118; no. 3; pp. 186 - 189
• Main Authors: Vigil-De Gracia, Paulino, Ortega-Paz, Luis
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.09.2012; Elsevier
• Subjects: Biological and medical sciences; Diseases of mother, fetus and pregnancy; Eclampsia; Eclampsia - diagnosis; Eclampsia - epidemiology; Female; Gynecology. Andrology. Obstetrics; HELLP syndrome; HELLP Syndrome - diagnosis; HELLP Syndrome - epidemiology; Hematologic and hematopoietic diseases; Hepatic rupture; Humans; Incidence; Liver Diseases - diagnosis; Liver Diseases - epidemiology; Maternal Mortality; Medical sciences; Obstetrics and Gynecology; Perinatal Mortality; Platelet diseases and coagulopathies; Pre-eclampsia; Pre-Eclampsia - diagnosis; Pre-Eclampsia - epidemiology; Pregnancy; Pregnancy. Fetus. Placenta; Rupture, Spontaneous - diagnosis; Rupture, Spontaneous - epidemiology; Maternal mortality; Pre-eclampsia; Hepatic rupture; Eclampsia; HELLP syndrome; Prognosis; Pregnancy disorders; Liver; Gynecology; Mortality; Rupture; Hemopathy; Epidemiology; Obstetrics; Pregnancy toxemia; Mother; Preeclampsia
• ISSN: 0020-7292; 1879-3479; 1879-3479
• DOI: 10.1016/j.ijgo.2012.03.042

Abstract Objective To review case reports of hepatic hematoma/rupture in women with pre-eclampsia/eclampsia. Methods MEDLINE, SciELO, and LILACS databases were searched for case reports of pre-eclampsia/eclampsia with hepatic hematoma/rupture. Only articles written in English, Spanish, French, or Portuguese and published between 1990 and 2010 were reviewed. Results In total, 180 cases of hepatic hematoma or rupture were identified: 18 (10.0%) with subcapsular hematoma without hepatic rupture; and 162 (90.0%) with capsule rupture. Twelve (6.7%) cases were associated with eclampsia plus hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Average age was 30.9 ± 5.0 years, 74/129 (57.4%) women were parous, and cesarean delivery was performed in 132/162 (81.5%) cases. The right lobule was the most frequently affected 77/100 (77.0%). The total maternal mortality rate was 22.2% during the 21 years; however, it decreased to 16.4% in the last decade studied. The perinatal mortality rate was 30.7% and was very similar during the 2 decades. Conclusion HELLP syndrome is a frequent diagnosis (92.8%) in hepatic hemorrhage/rupture. The major reduction in maternal mortality rate was probably associated with advances in resuscitation, intensive-care medicine, and surgical intervention, including liver transplantation and arterial embolization.