A Fatal Case of Complicated HELLP Syndrome and Antepartum Eclamptic Fit with Ruptured Subcapsular Liver Hematoma

Abstract

A 25-year-old woman developed HELLP syndrome and antepartum eclamptic fit complicated with ruptured subcapsular liver hematoma during the 28th week of pregnancy. Intervention: Midline abdominal exploratory laparotomy, with delivery by caesarean section. Tight abdominal packing for the hematoma and Pringle maneuver were done. Partial couvelaire uterus was managed by prostaglandins and B-Lynch brace sutures to minimize uterine bleeding and atony. The patient developed postoperative hepatic, renal failure, coagulopathy, deterioration and finally death. Conclusion(s):Ruptured subcapsular liver hematoma is a life-threatening condition that should be considered in pregnant women with HELLP syndrome and severe preeclampsia presenting with symptoms and signs of hemorrhagic shock, hemoperitoneum and the liver should be evaluated with ultrasound before delivery. In these patients delivery of the fetus is the first step and the best approach is a midline abdominal incision. Also, regular antenatal care is very important through all trimesters.

A complicated case of antepartum eclamptic fit with HELLP syndrome, acute renal failure and multiple intracranial hemorrhages: A mortality report

“…The pathogenesis of preeclampsia is believed to be associated with placental ischemia, endothelial dysfunction, cytotoxic and genetic factors. Severe preeclampsia is defined by systolic arterial pressure levels that are persistently P160 mmHg or diastolic arterial pressure P110 mmHg, massive proteinuria (4+ in a dipstick, or >2.0 g/24 h), or the presence of clinical (epigastric pain, nausea, and vomiting) and laboratory (platelet count <50,000/mm 3 , creatine kinase >200 U/L, LDH >1400 U/L, AST >150 U/L, ALT >100 U/l, uric acid >7.8 mg/dL, and serum creatinine >1.2 mg/dL) manifestations [4,5].…”