Spontaneous Intrahepatic Hemorrhage and Hepatic Rupture in the HELLP Syndrome

Abstract

Subcapsular hemorrhage and hepatic rupture are unusual catastrophic complications of the HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. A high index of suspicion and prompt recognition are keys to proper diagnosis and management of affected patients. The optimal management of these patients is evolving. An aggressive multidisciplinary approach has considerably improved the morbidity and mortality associated with these complications. We present our experience with four cases of hepatic hemorrhage occurring in association with the HELLP syndrome and review the literature on this subject. All of our patients were multiparous, and three had a history of eclampsia/preeclampsia in a previous pregnancy. All four patients developed intrahepatic hemorrhage; two developed hepatic rupture requiring surgical intervention. Three patients developed disseminated intravascular coagulation and acute renal failure. Two patients developed pericardial effusion, pleural effusions, and ascites. One patient died of septic complications after multiple surgical interventions.

Modified Rapid Deployment Hemostat Terminates Bleeding From Hepatic Rupture in Third Trimester

“…This presentation has been previously described [3][4][5][6][7] as Spontaneous Hepatic Hemorrhage in Pregnancy (SHHP) and generally occurs in one in 15,000 births. 3 Most experts feel this syndrome is related to the pre-eclampsia associated HELLP Syndrome, or one of several variants of this microangiopathic thrombosis syndrome.…”

Spontaneous liver rupture in hypereosinophilic syndrome: Arare but fatal complication

“…This has also been described in patients with HELLP syndrome, Ehlers Danlos disease and graft-vs-host disease [3][4][5][6] . In this report, we described a rare case of spontaneous liver rupture in a patient with hypereosinophilic syndrome (HES), of which the diagnosis was delayed, resulting in a fatal outcome.…”

Hepatic involvement in HELLP syndrome: an update with emphasis on imaging features

“…Risk factors for HELLP syndrome include multiparity, advanced maternal age, previous pregnancy with eclampsia/preeclampsia, and family history of HELLP syndrome [17]. Sisters and daughters of women who develop HELLP syndrome are at higher risk of developing the syndrome.…”

“…Hepatic rupture with hemoperitoneum can be treated conservatively using transcatheter hepatic artery embolization or surgically using liver packing, arterial ligation, partial liver resection, or orthotopic liver transplantation [7,17]. However, transcatheter hepatic artery embolization may help minimize morbidity and maternal mortality and is now considered as the treatment of choice [7].…”