Severe hepatic rupture in HELLP syndrome

Česká verzia

Authors: H. Y. Nghiemová ; M. Mojhová ; Michal Zikán
Authors place of work: Gynekologicko-porodnická klinika 1. LF UK a FN Bulovka, Praha
Published in the journal: Ceska Gynekol 2023; 88(2): 100-105
Category: Kazuistika
doi: https://doi.org/10.48095/cccg2023100

Summary

Objective: To describe the multidisciplinary approach that led to the successful management of severe hepatic rupture in HELLP syndrome at 35 weeks of gestation. Case report: The clinical course and management procedure of a 34-year-old female patient with ruptured liver due to HELLP syndrome, who was admitted with symptoms lasting about 4 hours (pain in the right hypochondrium, nausea, vomiting, flashes before the eyes) are described in the form of a case report. An acute caesarean section was performed, during which a rupture of the subcapsular hematoma of the liver was diagnosed. Subsequently, the patient developed hemorrhagic shock and coagulopathy with the need for repeated surgical revisions of bleeding from the rupture of the liver. Conclusion: Subcapsular hematoma rupture is a rare but serious complication of HELLP syndrome. This case shows the importance of early diagnosis and prompt termination of pregnancy in the shortest possible time in pregnancy after 34 weeks. The most fundamental factor that influenced the patient‘s outcome and morbidity was the management of multidisciplinary cooperation and the correct timing of individual steps.

Keywords:

HELLP syndrome – preeclampsia – rupture of subcapsular hematoma of the liver

Zdroje

1. Lisonkova S, Razaz N, Sabr Y et al. Maternal risk factors and adverse birth outcomes associated with HELLP syndrome: a population‐based study. BJOG 2020; 127 (10): 1189–1198. doi: 10.1111/1471-0528.16225.

2. Vlk R, Procházka M, Měchurová A et al (eds). Preeklampsie. Praha: Maxdorf 2015: 252–282.

3. Leahomschi S, Calda P. Klinické využití nových biomarkerů preeklampsie. Actual Gyn 2016; 8: 29–33.

4. Triggianese P, Perricone C, Perricone R et al. HELLP syndrome: a complication or a new autoimmune syndrome? Reumatologia 2014; 6 (6): 377–383. doi: 10.5114/reum.2014.47 231

5. Fang CJ, Richards A, Liszewski MK et al. Advances in understanding of pathogenesis of aHUS and HELLP. Br J Haematol 2008; 143 (3): 336–348. doi: 10.1111/j.1365-2141.2008.073 24.x.

6. Mihu D, Costin N, Mihu CM et al. HELLP syndrome – a multisystemic disorder. J Gastrointestin Liver Dis 2007; 16 (4): 419–424.

7. Abildgaard U, Heimdal K. Pathogenesis of the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP): a review. Eur J Obstet Gynecol Reprod Biol 2013; 166 (2): 117–123. doi: 10.1016/j.ejogrb.2012.09.026.

8. Stojanovska V, Zenclussen AC. Innate and adaptive immune responses in HELLP syndrome. Front Immunol 2020; 11: 667. doi: 10.3389/fimmu.2020.00667.

9. Šimetka O, Michalec I, Zewdiová H et al. Průběh a výsledky 34 těhotenství komplikovaných syndromem HELLP. Ceska Gynekol 2010; 75 (3): 242–247.

10. Cavkaytar S, Ugurlu EN, Karaer A et al. Are clinical symptoms more predictive than laboratory parameters for adverse maternal outcome in HELLP syndrome? Acta Obstet Gynecol Scand 2007; 86 (6): 648–651. doi: 10.1080/00016340601185 384.

11. Ditisheim A, Sibai BM. Diagnosis and management of HELLP syndrome complicated by liver hematoma. Clin Obstet Gynecol 2017; 60 (1): 190–197. doi: 10.1097/GRF.0000000000000 253.

12. Trávníková M, Gumulec J, Kořístek Z et al. HELLP syndrom vyžadující plazmaferézu pro rozvoj multiorgánové dysfunkce s dominující encefalopatií, respirační a renální insuficiencí. Ceska Gynekol 2017; 82 (3): 202–205.

13. Koucký M, Toman A, Ryšavá R et al. Trombotické mikroangiopatie a těhotenství. Ceska Gynekol 2020; 85 (1): 18–28.

14. Wicke C, Pereira PL, Neeser E et al. Subcapsular liver hematoma in HELLP syndrome: evaluation of diagnostic and therapeutic options – a unicenter study. Am J Obstet Gynecol 2004; 190 (1): 106–112. doi: 10.1016/j.ajog.2003.08. 029.

15. Desssole S, Capobianco G, Virdis P et al. Hepatic rupture after cesarean section in a patient with HELLP syndrome: a case report and review of the literature. Arch Gynecol Obstet 2007; 276 (2): 189–192. doi: 10.1007/s00404-006-03 18-9.

16. Kaltofen T, Grabmeier J, Weissenbacher T et al. Liver rupture in a 28‐year‐old primigravida with superimposed pre‐eclampsia and hemolysis, elevated liver enzyme levels, and low platelet count syndrome. J Obstet Gynaecol Res 2019; 45 (5): 1066–1070. doi: 10.1111/jog.13 941.

17. Barton JR, Sibai BM. Hepatic imaging in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count). Am J Obstet Gynecol 1996; 174 (6): 1820–1827. doi: 10.1016/S00 02-9378 (96) 70216-8.

18. Marsh FA, Kaufmann SJ, Bhabra K. Surviving hepatic rupture in pregnancy – a literature review with an illustrative case report. J Obstet Gynaecol 2009; 23 (2): 109–113. doi: 10.1080/0144361031000074583.

19. Wilson SG, White AD, Young AL et al. The management of the surgical complications of HELLP syndrome. Ann R Coll Surg Engl 2014; 96 (7): 512–516. doi: 10.1308/003588414X13946184901362.

20. Reck T, Bussenius-Kammerer M, Ott R et al. Surgical treatment of HELLP syndrome-associated liver rupture – an update. Eur J Obstet Gynecol Reprod Biol 2001; 99 (1): 57–65. doi: 10.1016/S0301-2115 (01) 00358-X.

21. Šimetka O. HELLP syndrom – diagnostika a léčba – doporučený postup. Ceska Gynekol 2014; 79 (Suppl): 9–16.