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Ginecología y Obstetricia de México

Federación Mexicana de Ginecología y Obstetricia, A.C.
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2017, Number 03

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Ginecol Obstet Mex 2017; 85 (03)

Term pregnancy after hepatic rupture secondary to HELLP syndrome

Acosta-Martínez M, Covarrubias-Haiek F, Garteiz D, Vieyra-Cortés D, Kably-Ambe A
Full text How to cite this article

Language: Spanish
References: 10
Page: 212-215
PDF size: 189.18 Kb.


Key words:

Pregnancy, Preecplamsia, Eclampsia, HELLP syndrome, Hepatic rupture.

ABSTRACT

Backgroun: Hepatic rupture is a potentially fatal rare complication, which is diagnosed in 1 of each 100,000 to 250 000 pregnancies. Maternal mortality has been reported in up to 86% of the patients. In cases where there has been a diagnosis of HELLP syndrome, the presence of a hepatic hematoma has to be suspected since it could lead to a hepatic rupture and eventually death.
Clinic case: 46 year old female in late stage of pregnancy, following a hepatic rupture caused by HELLP syndrome and fetal demise of both fetuses in previous twin pregnancy. Her last pregnancy being of normal evolution, having been submitted to cesarean section without complications on her 37th week of gestation, and discharged on her third post-operative day showing a good evolution.
Conclusion: The multidisciplinary medical attention given to the patient, as well as the hospital infrastructure, allowed the patient to be kept in good health despite the hepatic rupture and hemorrhage presented. It is important to remember that one of the leading causes of maternal death around the world is hypertension during pregnancy. Therefore, patients have to be made conscious of the significance and importance of attending prenatal care on a regular basis and be given information on hypertension and its complications. Additionally, it is important that obstetricians keep in mind that although this is a rare complication, it can lead to a fatal outcome when presented.


REFERENCES

  1. Stella CL, Malik KM, Sibai BM. HELLP syndrome: an atypical presentation. Am J Obstet Gynecol 2008:e6-e8.

  2. Araujo AC, Leao MD, Nobrega MH, Bezerra PF, Pereira FV, Dantas EM, et al. Characteristics and treatment of hepatic rupture caused by HELLP syndrome. Am J Obstet Gynecol 2006;195(1):129-33.

  3. Vigil-De Gracia P. Maternal deaths due to eclampsia and HELLP syndrome. Int J Gynaecol Obstet 2009;104:90-4.

  4. Varotti G, Andorno E, Valente U. Liver transplantation for spontaneous hepatic rupture associated with HELLP syndrome. Int J Gynaecol Obstet 2010;111(1):84-5.

  5. Borrás D, Fortuño S, Díaz C, Diago V, Perales A. Rotura hepática asociada a preeclampsia y síndrome HELLP, con resultados catastróficos. Prog Obstet Ginecol 2009;52(7):402-6.

  6. Sanabria-Padrón VH, Hernández-Valencia M, Castañeda- Valladares FE, Aceves-Solano JY. Tratamiento conservador del hematoma hepático subcapsular en pacientes con preeclampsia y síndrome de HELLP coexistentes: reporte de caso y revisión bibliográfica. Ginecol Obstet Mex 2013;81:414-9.

  7. Reck Th, Bussenius-Kammerer B, Ott R, Müller V, Beinder E, Hohenberger W. Surgical treatment of HELLP sindromeassociated liver ruptura – an update. Eur J Obstet Gynecol Reprod Biol 2001;99(1):57-65.

  8. Emergui Y, Madsen MA, Rodríguez Rm Delgado CS, Figueras T, Prieto M. Rotura de hematoma hepático subcapsular en el embarazo: caso clínico y revisión bibliográfica. Clin Invest Gin Obst. 2016. Article in press.

  9. http://dx.doi.org/10.1016/j.gine.2016.04.006

  10. Quesnel C, Weber A, Mendoza D, Garteiz D. Hematoma hepático espontáneo en embarazo gemelar. Ginecol Obstet Mex 2012;80(2):110-4.




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Ginecol Obstet Mex. 2017;85