Liver rupture in pregnant women with preeclampsia or HELLP leads to maternal and fetal mortality: Study

Croatia: Hypertensive disorders in pregnancy complicated by liver rupture or hematoma are often diagnosed and treated late resulting in high fetal and maternal mortality, according to a systematic review of 391 reported cases. The study was published in the World Journal of Emergency Surgery on 08 July 2022. 

In hemodynamically unstable patients with preeclampsia/eclampsia or HELLP syndrome and right upper abdominal pain, spontaneous hepatic rupture during pregnancy/puerperium (SHRP) should be excluded. Liver transplantation and liver embolization contribute to maternal survival. The researchers further report that maternal and fetal mortality was significantly higher before the year 1990. Hemodynamic instability, eclampsia, and preeclampsia have a significant negative influence on maternal survival.

Spontaneous liver rupture in pregnancy is highly lethal, often unrecognized, and not completely understood. The study was conducted by Goran Augustin, School of Medicine, University of Zagreb, Zagreb, Croatia, and colleagues aimed to summarize and define the etiology, clinical presentation, risk factors, appropriate diagnostic methods, and therapeutic options for spontaneous hepatic rupture during SHRP complicated by the hypertensive disorder. 

For this purpose, the researchers conducted a literature search of online databases. Case reports of a spontaneous hepatic rupture or liver hematoma during pregnancy or puerperium as a complication of hypertensive disorders (preeclampsia, eclampsia, HELLP syndrome) were searched. There was no language restriction. Additional cases were determined by reviewing references from retrieved studies. PRISMA guidelines were applied for the data extraction and quality assessment.