Abstract
Objective
Subcapsular liver hematoma formation has been reported in less than 2% of pregnancies
complicated by HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome.
The purpose of this study was to identify the main diagnostic and therapeutic options
for management of these patients.
Study design
In this 10-year retrospective review, we performed a computer-directed search of all
cases of confirmed HELLP syndrome with hepatic hematoma treated in the surgical department
of our tertiary care referral medical center.
Results
Five patients with subcapsular liver hematoma in HELLP syndrome could be identified.
All patients received transabdominal ultrasound, computed tomography, or magnetic
resonance imaging. Conservative treatment was successful in three patients. Emergency
surgical intervention was necessary in two patients, including one liver transplantation.
Conclusion
The case series shows the full diagnostic spectrum with transabdominal ultrasound,
computed tomography, and magnetic resonance imaging, as well as the different therapeutic
options varying from conservative therapy to operative management, including liver
transplantation.
Keywords
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References
- Liver disease in pregnancy.N Engl J Med. 1996; 335: 569-576
- The liver in pregnancy.in: Zakim D Boyer T.D Hepatology: a textbook of liver disease. WB Saunders, Philadelphia1990
- Preeclampsia-associated hepatic hemorrhage and rupture: mode of management related to maternal and perinatal outcome.Obstet Gynecol Surv. 1999; 54: 196-202
- Rupture of the liver associated with pregnancy: a review of the literature and report of 2 cases.Obstet Gynecol Surv. 1976; 31: 763-773
- Hepatic hemorrhage and the HELLP syndrome: a surgeon's perspective.Am Surg. 1995; 61: 756-760
- Spontaneous liver hematoma in pregnancy not clearly associated with preeclampsia: a case presentation and literature review.Am J Obstet Gynecol. 1997; 176: 1328-1333
- Syndrome of hemolysis, elevated liver enzymes, and low platelet count: a severe consequence of hypertension in pregnancy.Am J Obstet Gynecol. 1982; 142: 159-167
- A review of HELLP syndrome.J Perinatol. 1999; 19: 138-143
- The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing?.Am J Obstet Gynecol. 1990; 162: 311-316
- Temporising management of severe pre-eclampsia with and without the HELLP syndrome.BJOG. 1995; 102: 111-117
- The spectrum of severe preeclampsia: comparative analysis by HELLP (hemolysis, elevated liver enzyme levels, and low platelet count) syndrome classification.Am J Obstet Gynecol. 1999; 180: 1373-1384
- Antepartum corticosteroids: disease stabilization in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP).Am J Obstet Gynecol. 1994; 171: 1148-1153
- Postpartum corticosteroids: accelerated recovery from the syndrome of hemolysis, elevated liver enzymes, and low platelets (HELLP).Am J Obstet Gynecol. 1994; 171: 1154-1158
- A prospective, randomized trial comparing the efficacy of dexamethasone and betamethasone for the treatment of antepartum HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.Am J Obstet Gynecol. 2001; 184: 1332-1339
- Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia.Am J Obstet Gynecol. 1986; 155: 501-509
- Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome).Am J Obstet Gynecol. 1993; 169: 1000-1006
- 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: 444-448
- The HELLP syndrome.BJOG. 1997; 104: 887-891
- Spontaneous intrahepatic hemorrhage and hepatic rupture in the HELLP syndrome: four cases and a review.J Clin Gastroenterol. 1999; 28: 323-328
- Pre-eclampsia and the HELLP syndrome still cause maternal mortality in The Netherlands and other developed countries; can we reduce it?.Eur J Obstet Gynecol Reprod Biol. 1999; 82: 41-46
- Preeclampsia as the great impostor.Am J Obstet Gynecol. 1991; 164: 1577-1581
- HELLP syndrome associated with factor V R506Q mutation.Br J Haematol. 1996; 92: 999-1001
- Maternal haemolysis, elevated liver enzymes and low platelets syndrome: specific problems in the newborn.Eur J Pediatr. 1993; 152: 160-163
- Maternal hemolysis, elevated liver enzymes, low platelet count, and neonatal outcome.Am J Perinatol. 1995; 12: 1-6
- Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome: a review of diagnosis and management.Semin Perinatol. 1998; 22: 118-133
- Pregnancy complicated by preeclampsia-eclampsia with the syndrome of hemolysis, elevated liver enzymes, and low platelet count: how rapid is postpartum recovery?.Obstet Gynecol. 1990; 76: 737-741
- Clinical utility of strict diagnostic criteria for the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome.Am J Obstet Gynecol. 1996; 175: 460-464
- Hepatic fibrinogen deposits in pre-eclampsia: immunofluorescent evidence.N Engl J Med. 1976; 295: 578-582
- Liver disease in toxemia of pregnancy.Am J Gastroenterol. 1986; 81: 1138-1144
- Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count).Am J Obstet Gynecol. 1992; 167: 1538-1543
- Imaging of subcapsular hepatic and renal hematomas in pregnancy complicated by preeclampsia and the HELLP syndrome.J Clin Ultrasound. 1999; 27: 35-40
- Hepatic hemorrhage without rupture in preeclampsia.N Engl J Med. 1985; 312: 424-426
- Hepatic imaging in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count).Am J Obstet Gynecol. 1996; 174 (discussion 1825–7): 1820-1825
- Hepatic rupture associated with pregnancy: treatment with transcatheter embolotherapy.Obstet Gynecol. 1985; 65: 281-284
- Postpartum rupture of a subcapsular hematoma of the liver.Acta Obstet Gynecol Scand. 1992; 71: 394-397
- Massive liver haemorrhage and rupture caused by HELLP-syndrome treated by collagen fleeces coated with fibrin glue.Eur J Surg. 1998; 164: 709-711
- Acute liver necrosis in the HELLP syndrome: successful outcome after orthotopic liver transplantation: a case report.Transpl Int. 1993; 6: 179-181
- Liver transplant after massive spontaneous hepatic rupture in pregnancy complicated by preeclampsia.Obstet Gynecol. 1995; 85: 819-822
Article info
Publication history
Accepted:
August 28,
2003
Received in revised form:
July 23,
2003
Received:
February 21,
2003
Identification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
