Unusual Complication Of HELLP Syndrome – Hepatic Rupture
HELLP syndrome (hemolysis, elevated Liver enzymes, low platelets) is a life threatening complication of pregnancy that carries a 1% mortality. Hepatic subcapsular hemorrhage and rupture is a rare and often fatal complication of HELLP syndrome.
A 23 year-old pregnant woman at 33 weeks gestational age was admitted with symptoms of pre-eclampsia and underwent emergent cesarean section. She developed hemorrhagic shock and abdominal ultrasound revealed intra-abdominal free fluid and perihepatic hematoma. CT angiogram did not reveal active bleeding. She was aggressively managed with fluids, vasopressors and blood product replacement. Subsequently, she developed acute renal failure and Klebsiella pneumonia bacteremia and septic shock. Patient expired on day 15 of hospitalization.
The incidence of hepatic rupture is approximately 1 : 45,000 to 1 : 225,000 deliveries. Risk factors include older age, multigravida and pre-eclampsia. Patients without active bleeding can be managed with close hemodynamic monitoring and blood product transfusion. The mortality associated with liver rupture is 10–30%.
Hepatic rupture is a potentially fatal complication of HELLP syndrome. Right upper quadrant pain with hypotension in a patient with HELLP syndrome should alert the physician to this condition.....