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[Hepatic haemorrhage in pregnancy: a case report].
G Chir. 2005 Jan-Feb; 26(1-2):47-51.GC

Abstract

Spontaneous hepatic haemorrhage in pregnancy (SHHP) is a rare event (1 woman out of 15,000). It is generally considered as an advanced state of the microangiopathic hemolytic anemia (HELLP, Hemolysis, Elevated Liver enzyme levels, Low Platelet count). Furthermore, the HELLP is considered as a different form of preeclampsia. The patient, a 33-year-old-woman at 30 weeks' gestation, was admitted to hospital for preeclampsia, underwent an emergency Stark caesarean section with the extraction of an alive foetus and evidence of massive intraperitonal haemorrhage from a large hepatic haematoma. A haemostasis with gauzes of Surgicel was performed, with consequent arrest of the haemorrhage. After approximately 6 hours, a recurrence of the intraperitonal haemorrhage led to a new surgical intervention with hepatic packing with gauzes. After 4 days the patient died. The etiopathogenesis of disease is uncertain, both foetal and maternal mortality are high, and the slight number of reported cases (27) of SPPH from HELLP in international literature offer elements for debate. The following points have been put forward: 1. the monitoring of the counts of the platelets represent the only valid predictive test of HELLP. These concerned women in the third trimester of pregnancy, especially those with a history of preeclampsia; 2. the treatment must be immediate, intensive and multidisciplinary, the plasmapheresis has remarkably improved the prognosis; 3. surgical treatment performed in order to control the SPPH makes use of packing, embolization and/or fastening of the common hepatic artery and, in extreme cases, total hepatectomy with transplantation. The Authors believe it is useful to suggest a national epidemiological research in order to estimate the real incidence of the syndrome in Italy and to establish the guidelines for the medico-surgical treatment.

Authors+Show Affiliations

D'Ambrosio R
Unità Operativa di Chirurgia d'Urgenza, Azienda Ospedaliera "San Sebastiano" di Rilievo Nazionale ed Alta Specializzazione, Caserta.
Capasso L
No affiliation info available
Sgueglia S
No affiliation info available
Casale LS
No affiliation info available
Buonincontro S
No affiliation info available
Carfora E
No affiliation info available
Iodice A
No affiliation info available
Borsi E
No affiliation info available

MeSH

AdultCellulose, OxidizedCesarean SectionFemaleHELLP SyndromeHematomaHemoperitoneumHemostasis, SurgicalHemostatic TechniquesHumansInfant, NewbornLiver DiseasesPlasmapheresisPregnancyPregnancy ComplicationsPrognosisRecurrenceTime Factors

Pub Type(s)

Case Reports
English Abstract
Journal Article

Language

ita

PubMed ID

15847096

Citation

D'Ambrosio, R, et al. "[Hepatic Haemorrhage in Pregnancy: a Case Report]." Il Giornale Di Chirurgia, vol. 26, no. 1-2, 2005, pp. 47-51.
D'Ambrosio R, Capasso L, Sgueglia S, et al. [Hepatic haemorrhage in pregnancy: a case report]. G Chir. 2005;26(1-2):47-51.
D'Ambrosio, R., Capasso, L., Sgueglia, S., Casale, L. S., Buonincontro, S., Carfora, E., Iodice, A., & Borsi, E. (2005). [Hepatic haemorrhage in pregnancy: a case report]. Il Giornale Di Chirurgia, 26(1-2), 47-51.
D'Ambrosio R, et al. [Hepatic Haemorrhage in Pregnancy: a Case Report]. G Chir. 2005 Jan-Feb;26(1-2):47-51. PubMed PMID: 15847096.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Hepatic haemorrhage in pregnancy: a case report]. AU - D'Ambrosio,R, AU - Capasso,L, AU - Sgueglia,S, AU - Casale,L S, AU - Buonincontro,S, AU - Carfora,E, AU - Iodice,A, AU - Borsi,E, PY - 2005/4/26/pubmed PY - 2005/5/14/medline PY - 2005/4/26/entrez SP - 47 EP - 51 JF - Il Giornale di chirurgia JO - G Chir VL - 26 IS - 1-2 N2 - Spontaneous hepatic haemorrhage in pregnancy (SHHP) is a rare event (1 woman out of 15,000). It is generally considered as an advanced state of the microangiopathic hemolytic anemia (HELLP, Hemolysis, Elevated Liver enzyme levels, Low Platelet count). Furthermore, the HELLP is considered as a different form of preeclampsia. The patient, a 33-year-old-woman at 30 weeks' gestation, was admitted to hospital for preeclampsia, underwent an emergency Stark caesarean section with the extraction of an alive foetus and evidence of massive intraperitonal haemorrhage from a large hepatic haematoma. A haemostasis with gauzes of Surgicel was performed, with consequent arrest of the haemorrhage. After approximately 6 hours, a recurrence of the intraperitonal haemorrhage led to a new surgical intervention with hepatic packing with gauzes. After 4 days the patient died. The etiopathogenesis of disease is uncertain, both foetal and maternal mortality are high, and the slight number of reported cases (27) of SPPH from HELLP in international literature offer elements for debate. The following points have been put forward: 1. the monitoring of the counts of the platelets represent the only valid predictive test of HELLP. These concerned women in the third trimester of pregnancy, especially those with a history of preeclampsia; 2. the treatment must be immediate, intensive and multidisciplinary, the plasmapheresis has remarkably improved the prognosis; 3. surgical treatment performed in order to control the SPPH makes use of packing, embolization and/or fastening of the common hepatic artery and, in extreme cases, total hepatectomy with transplantation. The Authors believe it is useful to suggest a national epidemiological research in order to estimate the real incidence of the syndrome in Italy and to establish the guidelines for the medico-surgical treatment. SN - 0391-9005 UR - https://www.unboundmedicine.com/medline/citation/15847096/[Hepatic_haemorrhage_in_pregnancy:_a_case_report]_ DB - PRIME DP - Unbound Medicine ER -