Therapeutic Management of Sous Capsular Hematoma of the Liver Complicating Pre-eclampsia

Abstract

Subcapsular hematoma of the liver is a rare and extremely serious complication of pre-eclampsia. Its rupture is one of the most serious obstetric complications. Liver HSC occurs in the context of HELLP syndrome in pre-eclampsia, with a maternal mortality rate of 50% to 75% and a fetal mortality rate of 60% to 80%. Treatment is based on a multidisciplinary approach involving anesthetists, obstetricians, radiologists, surgeons and pediatricians. The aim of our study was to examine the epidemiological and clinical profile of this complication, the circumstances in which it occurred, the treatment methods and its evolution. Patients were collected from the anaesthesia-intensive care unit of the maternity ward of the CHU Ibn Rochd in Casablanca, Morocco, over a 5-year period from January 2022 to December 2023. We collected eight cases; the average age of our patients was 33.37 years with extremes between 20 and 40 years. Six were multiparous. The antecedents included 3 fetal deaths in utero. The mean gestational age was 33.62 SA. All were pre-eclampsia. The diagnosis was made during the prepartum period in one case, intraoperatively in four cases and postpartum in three cases. Pain was present in all patients and was epigastric or in the right hypochondrium. All parturients developed HELLP syndrome. Two patients were able to undergo vaginal delivery, and six underwent caesarean section. All 8 cases were transfused with labile blood products. Surgical treatment consisted of packing in five women, only one of whom required ligation of the right hepatic artery. Therapeutic abstention was adopted in three patients. We noted only one maternal death.