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Postpartum spontaneous rupture of a liver hematoma associated with preeclampsia and HELLP syndrome.
Arch Gynecol Obstet. 2009 Jun; 279(6):923-6.AG

Abstract

We report the case of a 28-year-old nulliparous woman who presented at 36 weeks' gestation with preeclampsia: high blood pressure, proteinuria and edema. Serum test results were normal and platelet count was 155 x 10(3)/mm(3). After 30 h the patient initiated severe epigastric pain and vomits, and lab tests presented a slight increase in liver enzymes. The platelet count remained above 150,000/microL. Cesarean section (CS) was performed. Six hours after CS, she developed a hypovolemic shock and lab tests became increasingly abnormal (liver enzymes increased sharply and hemoglobin and platelet count decreased sharply). Abdominal ultrasound showed suggestive signs of hepatic rupture. The patient was stabilized and exploratory laparotomy was performed. Perihepatic packing was applied. The patient was discharged after 25 days of admission (15 days at the ICU) and three explorative laparotomies. This case highlights the unpredictability of this event based on the changes of liver enzyme values, LDH and platelet count. These changes only occurred when the rupture had already occurred and the patient was in hypovolemic shock.

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Authors+Show Affiliations

Miguelote RF
Department of Obstetrics and Gynaecology, Alto Ave Hospital Center, Guimarães, Portugal. rfmiguelote@netcabo.pt
Costa V
No affiliation info available
Vivas J
No affiliation info available
Gonzaga L
No affiliation info available
Menezes CA
No affiliation info available

MeSH

AdultFemaleHELLP SyndromeHematomaHumansLiver DiseasesPostpartum PeriodPre-EclampsiaPregnancyRupture, Spontaneous

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

18979111

Citation

Miguelote, Rui Filipe, et al. "Postpartum Spontaneous Rupture of a Liver Hematoma Associated With Preeclampsia and HELLP Syndrome." Archives of Gynecology and Obstetrics, vol. 279, no. 6, 2009, pp. 923-6.
Miguelote RF, Costa V, Vivas J, et al. Postpartum spontaneous rupture of a liver hematoma associated with preeclampsia and HELLP syndrome. Arch Gynecol Obstet. 2009;279(6):923-6.
Miguelote, R. F., Costa, V., Vivas, J., Gonzaga, L., & Menezes, C. A. (2009). Postpartum spontaneous rupture of a liver hematoma associated with preeclampsia and HELLP syndrome. Archives of Gynecology and Obstetrics, 279(6), 923-6. https://doi.org/10.1007/s00404-008-0829-7
Miguelote RF, et al. Postpartum Spontaneous Rupture of a Liver Hematoma Associated With Preeclampsia and HELLP Syndrome. Arch Gynecol Obstet. 2009;279(6):923-6. PubMed PMID: 18979111.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postpartum spontaneous rupture of a liver hematoma associated with preeclampsia and HELLP syndrome. AU - Miguelote,Rui Filipe, AU - Costa,Vera, AU - Vivas,José, AU - Gonzaga,Luís, AU - Menezes,Carlos Alpoim, Y1 - 2008/11/01/ PY - 2008/08/07/received PY - 2008/10/14/accepted PY - 2008/11/4/pubmed PY - 2009/7/16/medline PY - 2008/11/4/entrez SP - 923 EP - 6 JF - Archives of gynecology and obstetrics JO - Arch Gynecol Obstet VL - 279 IS - 6 N2 - We report the case of a 28-year-old nulliparous woman who presented at 36 weeks' gestation with preeclampsia: high blood pressure, proteinuria and edema. Serum test results were normal and platelet count was 155 x 10(3)/mm(3). After 30 h the patient initiated severe epigastric pain and vomits, and lab tests presented a slight increase in liver enzymes. The platelet count remained above 150,000/microL. Cesarean section (CS) was performed. Six hours after CS, she developed a hypovolemic shock and lab tests became increasingly abnormal (liver enzymes increased sharply and hemoglobin and platelet count decreased sharply). Abdominal ultrasound showed suggestive signs of hepatic rupture. The patient was stabilized and exploratory laparotomy was performed. Perihepatic packing was applied. The patient was discharged after 25 days of admission (15 days at the ICU) and three explorative laparotomies. This case highlights the unpredictability of this event based on the changes of liver enzyme values, LDH and platelet count. These changes only occurred when the rupture had already occurred and the patient was in hypovolemic shock. SN - 1432-0711 UR - https://www.unboundmedicine.com/medline/citation/18979111/Postpartum_spontaneous_rupture_of_a_liver_hematoma_associated_with_preeclampsia_and_HELLP_syndrome_ L2 - https://dx.doi.org/10.1007/s00404-008-0829-7 DB - PRIME DP - Unbound Medicine ER -