Hepatic Hemorrhage and Rupture in Pregnancy: How to Survive

Abstract

Hepatic Hemorrhage and Rupture in Pregnancy: How to Survive

Waralak Yamasmit MD

Sanitra Anuwutnavin MD

Department of Obstetrics and Gynecology, BMA Medical College and Vajira Hospital

Hepatic hemorrhage and rupture during pregnancy is rare but carries a maternal and perinatal mortality. Almost all of affected women are associated with preeclampsia. The most common presenting symptom is epigastric or right upper quadrant pain. The best imaging modalities is computed tomography with contrast. Successful outcome requires a multidisciplinary team approach. Prompt and adequate resuscitation with intravenous fluid, blood and blood component transfusions are the most important part of initial management. Therapeutic options are observation, selective arterial embolization, porta hepatis compression or packing with laparotomy sponges, hepatic artery ligation, Argon beam electrocoagulation, hepatic resection or liver transplantation. However, there is still no consensus on the best approach to treat this complication. Patients' conditions, the severity of liver damage, and the availability of resources and medical personals are the factors determining the therapeutic strategy.

Keywords: hepatic hemorrhage, hepatic rupture, pregnancy

Vajira Med J 2010 ; 54 : 209-214