Spontaneous hepatic rupture during emergency cesarean section in a patient with HELLP syndrome: A case report and literature review

Abstract

Spontaneous hepatic rupture is a rare but life-threatening complication of pregnancy. Case Report: A 30-year-old woman with multi-para pregnancy was admitted to the hospital at 31+3 weeks of gestation who complained of abdominal pain localized in the right upper quadrant on the third day after admission. HELLP syndrome was diagnosed, and emergency cesarean section was performed. Within several hours, blood biochemistry revealed significant elevated liver enzymes and reduced platelet (PLT) count. HELLP syndrome was diagnosed and emergency cesarean section was performed. The authors also made a literature review on the reported cases with spontaneous hepatic rupture during pregnancy in mainland China. A total 39 cases were found. Maternal survival was 78.9% (30/38) and perinatal survival was 50% (21/42). Deaths occurred mainly due to disseminated intravascular coagulation (DIC), acute renal failure, respiratory failure, and so on. An emergency physician should be aware that early evaluation, appropriate diagnosis, and prompt surgical intervention are crucial to deal with such a life-threatening emergency. Multidisciplinary cooperation between obstetricians, surgeons, and pediatricians is required for treating spontaneous hepatic rupture during pregnancy.