Abstract

Background: Spontaneous hepatic rupture during pregnancy is a rare but potentially fatal complication associated with hypertensive disorders of pregnancy and maternalfetal mortality rates reaching up to 80%. We report the case of a 45-year-old woman with spontaneous hepatic rupture at 31 weeks of gestation associated with superimposed preeclampsia on chronic hypertension. Case presentation: A 45-year-old gravida 2, para 0, abortus 1 woman with untreated chronic hypertension and no prenatal follow-up presented with severe epigastric pain at 31 weeks of gestation. Obstetric ultrasound demonstrated intrauterine fetal demise. Emergency laparotomy revealed 2800 mL hemoperitoneum and a ruptured subcapsular hepatic hematoma. Hepatic packing and multidisciplinary critical care management were successfully performed. Conclusion: Spontaneous hepatic rupture should be suspected in hypertensive pregnant patients presenting with sudden epigastric pain and hemodynamic instability. Early diagnosis and immediate multidisciplinary surgical management are crucial to reduce maternal and fetal morbidity and mortality.

Keywords

spontaneous hepatic rupture; pregnancy, preeclampsia, hellp syndrome, hemoperitoneum, shock