Hepatic hematoma in HELLP syndrome

Authors

  • Maida Alassia Servicio de Tocoginecología. Hospital Materno Neonatal. Córdoba.
  • María Marta Buteler Servicio de Tocoginecología. Hospital Materno Neonatal. Córdoba.
  • Cecilia Caffaratti Servicio de Tocoginecología. Hospital Materno Neonatal. Córdoba.
  • Hector Bollatti Servicio de Tocoginecología. Hospital Materno Neonatal. Córdoba.
  • Maria Marta Caratti Servicio de Tocoginecología. Hospital Materno Neonatal. Córdoba.

DOI:

https://doi.org/10.31053/1853.0605.v68.n3.21530

Abstract

Objective: The purpose of this study was to review our experience with patients having hepatic rupture or hematoma caused by HELLP syndrome.
Materials and Methods: Descriptive simple cross sectional retrospective study. A review was performed of medical records of all patients admitted at our Hospital´s intensive care unit having HELLP syndrome during pregnancy or puerperium between February 1999 and February 2010. Patients complicated with hematoma or hepatic rupture were included. 
Results: Three cases were identified. The average maternal age was 35 years old and the average gestational age at delivery was 33 weeks. The most frequent signs and symptoms were sudden onset of abdominal pain and shock. A distinctive laboratory finding was anemia. Surgical treatment was omental patching in one of the patients and it was conservative with drainages in the other two cases. Maternal and perinatal mortality were 33 %.
Conclusion: Based on our experience and the literature review, we can conclude that hepatic hematoma and rupture associated with HELLP syndrome represent a life-threatening complication in which early detection is very important to achieve a proper diagnosis and treatment. Patients should be treated by a multidisciplinary team in reference centers being carefully followed with adequate hemodynamic support and regular images to improve the survival maternal rate. 

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References

Barton JR, Sibai BM. Care of the pregnancy complicated by HELLP syndrome. Gastroenterol Clin North Am 1992; 21:937-50.

Smith LG, Moise KJ, Dildy GA III, Carpenter RJ Jr. Spontaneous rupture of the liver during pregnancy: current therapy. Obstet Gynecol 1991; 177:171-5.

Nelson DB, Dearmons V, Nelson MD. Spontaneous rupture of the liver during pregnancy: a case report. J Obstet Gynecol Neonatal Nurse 1989; 18:106-13.

Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Much ado about nothing? Am J Obstet Gynecol 1990; 162:311-6.

Wicke C, Pereira PL, Neeser E, Flesch I, Rodegerdts EA, Becker HD. Subcapsular hepatic hematoma in HELLP syndrome:

evaluation of diagnostic and therapeutic options: a unicenter study. Am J Obstet Gynecol 2004;190:106-12.

Gonzalez GD, Rubel HR, Giep NN, Bottsforf JE Jr. Spontaneous hepatic rupture in pregnancy: management with hepatic artery ligation. South Med J 1984; 77:242-5.

Gonzalez AL, Romero Arauz JF, Tenorio Maranon R. Long-term course of liver rupture in preeclampsia: a case report. Ginecol

Obstet Mex 2000;68:353-6.

Bis KA, Waxman B. Rupture of the liver associated with pregnancy: a review of the literature and report of 2 cases. Obstet Gynecol Surv 1976;31:763-73.

Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993;169:1000-6.

Rinehart BK, Terrone DA, Magann FF, Martin RW, May WL, Martin JN Jr. Preeclampsia associated hepatic hemorrhage and rupture: mode of management related to maternal and perinatal outcome. Obstet Gynecol Surv 1999;54:196-202.

Audibert F, Friedman SA, Frangieh AY, Sibai BM. Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. Am J Obstet Gynecol 1996;175:460-4.

Sheikh RA, Yasmeen S, Pauly MP, Riegler JL. Spontaneous intrahepatic hemorrhage and hepatic rupture in the HELLP syndrome: four cases and a review. J Clin Gastroenterol 1999;28: 323-8.

Reck T, Bussenius-Kammerer M, Ott R, Muller V, Beinder E, Hohenberger W. Surgical treatment of HELLP syndromeassociated

liver rupture- an update. Eur J Obstet Gynecol Reprod Biol 2001;99:57-65.

Risseeuw JJ, de Vries JE, Van Eyck J, Arabian B. Liver ruptura postpartum associated with preeclampsia and HELLP syndrome. J Matern Fetal Med 1999;8:32-5.

Carlson KL, Bader CL. Rupturedsubcapsular liver hematoma in pregnancy: a case report of nonsurgical management. Am J Obstet Gynecol 2004;190:558-60.

Haddad B, Barton JR, Livingston JC, Chahine R, Sibai BM. Risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes and low platelet count) syndrome. Am J Obstet Gynecol 2000;183:444-8.

Ana C. P. F. Araujo, MD, PhD,a,b Marcos D. Leao, MD,b Maria H. Nobrega, MD, PhD,a,b Patricia F. M. Bezerra, MD,a,b Flavio V. M. Pereira, MD,b Edailna M. M.Dantas, MD,b George D. Azevedo, MD, PhD,b,c Selma M. B. Jeronimo, MD, PhDb,d,* Characteristics and treatment of hepatic rupture caused by HELLP syndrome. American Journal of Obstetrics and Gynecology (2006) 195, 129–33

Santos-BolívarJ ,y colaboradores .Rotura de hematoma subcapsular hepático como complicación del síndrome de HELLP.CirEsp.2009.doi:10.1016/j.ciresp.2008.12.014

Eduardo Revilla Rodríguez, Fred Rivera Cruz,Hugo Sarmiento Jiménez, María del Rocío Ruiz Olivera, Héctor Vásquez Revilla,

Juventino López Ruptura hepática en una paciente con preeclampsia y ligadura de arteria hepática común. Reporte de un caso. Vol. XXII, Núm. 4 / Oct.-Dic. 2008 pp 254-259 Revista de la Asociación Mexicana de

Rodriguez, E, Tellez Valdez J, Cadena R, Ontivero L B, Acosta Patiño J, Tejada pelayo C. Síndrome de Hellp y Hematoma subcapsular hepático. Reporte de 1 caso. Salud en Tabasco Enero- Abril 2007 pag 597-601 Mexico

Pérez A, Martinez W, Hoefler S., Mollo A.E, Campaña GV, Czwiklitzer G. Hematoma subcapsular hepático roto asociado

a preeclampsia severa y síndrome de HELLP como urgencia quirúrgica. Técnica quirúrgica Rev. Chilena de Cirugía. Vol 59 -

Nº 6, Diciembre 2007; págs. 403-407

Pilco P, Mc Cormack L, Perez D, Clavien PA. Hematoma hepático subcapsular roto en el síndrome de Hellp. Revisión de la bibliografía y reporte de un caso con manejo conservador. Revista de gastroenterología , Perú 2006 ; 26 207 -210

González, A, Moreno Conejo R. Preeclampsia y ruptura hepática. Informe de tres casos. Rev Med IMSS 2002; 40 (6): 505-510 505

Published

2011-09-02

How to Cite

1.
Alassia M, Buteler MM, Caffaratti C, Bollatti H, Caratti MM. Hepatic hematoma in HELLP syndrome. Rev Fac Cien Med Univ Nac Cordoba [Internet]. 2011 Sep. 2 [cited 2024 Jul. 17];68(3):119-24. Available from: https://revistas.unc.edu.ar/index.php/med/article/view/21530

Issue

Section

Case Report