Recurrent spontaneous hepatic rupture in pregnancy: A case report.

Abstract:

RATIONALE:Spontaneous and repeated hepatic ruptures caused by hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome are uncommon but life-threatening conditions that rarely occur early in the second trimester of pregnancy. PATIENT CONCERNS:We describe a patient who experienced spontaneous hepatic ruptures in the absence of hypertension during the early second trimesters of both her first and second pregnancies. DIAGNOSES:A 34-year-old multiparous woman without hypertension was admitted at 21 weeks' gestation because of a spontaneous hepatic rupture with hemoperitoneum. Four years previously, the patient had undergone an exploratory laparotomy during her first pregnancy that involved the ligation of bleeders, because a hepatic capsule rupture had caused hemoperitoneum development. INTERVENTIONS:Unlike the first pregnancy, she was managed nonsurgically and conservatively during the second pregnancy, and she underwent frequent laboratory analyses and magnetic resonance imaging follow-up. On day 11 of the patient's hospital admission, we decided to deliver the baby at 23 weeks' gestation, because her condition had deteriorated. OUTCOMES:Non-surgical management improved the patient's outcome, and the baby was born alive, even though the pregnancy was in the early second trimester and the maternal condition was deteriorating rapidly. LESSONS:HELLP syndrome without hypertension and the recurrence of an intrahepatic rupture at an extremely premature gestational age are rare. This patient's findings suggested HELLP syndrome, which was subsequently diagnosed. This patient's clinical course highlights the difficult decisions made by clinicians for mothers and fetuses.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Han GH,Kim MA

doi

10.1097/MD.0000000000011458

subject

Has Abstract

pub_date

2018-07-01 00:00:00

pages

e11458

issue

29

eissn

0025-7974

issn

1536-5964

pii

00005792-201807200-00027

journal_volume

97

pub_type

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