Spontaneous hepatic rupture in HELLP syndrome. A review of the literature

Abstract

Introduction: HELLP syndrome affects up to 20% of pregnant women with preeclampsia and is associated with high rates of maternal and fetal mortality. Spontaneous liver rupture is a life-threatening complication of HELLP syndrome, affecting 1 in 45,000 - 260,000 pregnancies, multiparous; in the age of forty; after 32 weeks of gestation. Objective: To conduct a narrative review of the current literature on spontaneous liver rupture associated with HELLP syndrome. Methodology:  A bibliographic review was conducted in the electronic databases of Pubmed, Redalyc, ScienceDirect, SciELO of scientific publications related to the objective of the review. Results: Hepatic rupture is the rupture of a compressive hepatic subcapsular hematoma, these hematomas usually occur in five out of seven women with severe preeclampsia or HELLP syndrome. Pathophysiologically fibrin deposits and vasospasm in pregnancy lead to increased liver pressure and necrosis, causing liver rupture. Clinical manifestations include right upper quadrant pain, epigastric pain, vomiting, and hemodynamic shock. It is usually diagnosed from the surgical finding associated with injury and maternal and / or fetal risk. Therapeutic approaches range from conservative management to liver transplantation. Conclusions: Spontaneous hepatic rupture of a subcapsular hepatic hematoma caused by HELLP syndrome is a rare but life-threatening complication, which usually occurs between weeks 28 and 36 of gestation. Clinical manifestations include epigastric pain, sudden right quadrant pain, and hemodynamic shock. If rupture is suspected, complementary examinations include ultrasound. Treatment can range from conservative management, emergency laparotomy, arterial embolization to liver transplantation.