Fatal Postpartum Spontaneous Liver Rupture: Case Report and Literature Review

Abstract

Maternal hepatic rupture is a rare complication of pregnancy that can be fatal to both mother and child. This phenomenon is most often associated with preeclampsia/eclampsia and/or HELLP syndrome, which is defined by a collection of clinical features including hemolysis (H), elevated liver enzymes (EL), and a low platelet count (LP). These disease processes are typically identified and treated during pregnancy, often in the last trimester. The described case is unusual in that the decedent had no known history of preeclampsia/eclampsia or HELLP syndrome during this pregnancy, and she died suddenly several days postpartum of liver rupture with massive intraperitoneal hemorrhage following a routine cesarean section delivery and an uneventful hospital course. Similar cases are infrequent in the literature, which is reviewed in this report.

Pregnancy-associated Death – Clarifying the Cause of Death and Medico-legal Assessments in Accusations of Malpractice

“…Other causes of death reported in case histories include spontaneous rupture of an unscarred gravid uterus 19 , fatal methadone intoxication of a pregnant woman 18 , pregnancy outcomes after traffic accidents 22 , spontaneous postpartum liver rupture 47 , and acute postpartum coronary artery thrombosis in a woman receiving bromocriptine 29 . Other rare causes of deaths during pregnancy are pregnancy-associated disease, particularly Sheehanʼs syndrome 39 , 40 , 42 , 43 .…”

The management of the surgical complications of HELLP syndrome

“…We identified 34 cases in 16 publications describing hepatic rupture associated with HELLP syndrome (Appendix 1available online only). [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Four patients (12%) were treated Two patients underwent subsequent elective liver resection surgery, for intrahepatic haematoma and an atrophic left lobe due to recurrent cholangitis. Twenty-six patients underwent emergency surgery with eight requiring multiple laparotomies to manage the hepatic complications.…”

Complicaciones posparto del síndrome HELLP: diagnóstico post mórtem

“…En la literatura se recoge ampliamente como factor predisponente de la rotura de un hematoma hepático, la presencia de preeclampsia o de síndrome HELLP durante el embarazo, pero también algunos autores han descrito casos en los que se presenta aisladamente [10][11][12] . Destacamos que en nuestro caso la paciente tuvo un embarazo de evolución normal, con diabetes gestacional controlada, parámetros analíticos y cifras tensionales dentro de la normalidad, y al final de la gestación presentó un episodio de hipertensión arterial aislado que justificó su ingreso y la inducción del parto.…”