[Spontaneous rupture of the liver in HELLP syndrome]

Spontaneous hepatic rupture in pregnancy is a rare, but dangerous complication of acute or progressing pre-eclampsia. Pain in the right upper quadrant is the most important clinical symptom and should prompt immediate laboratory evaluation (transaminase, coagulation profile, platelet count, red and white blood count). If the diagnosis of HELLP syndrome is confirmed, close supervision in an intensive care unit is mandatory. The danger of pre- or postpartal open hepatic rupture must be considered. Pain in the right upper abdomen and signs of abdominal mass bleeding occurring within a HELLP syndrome are important evidence for hepatic rupture. Immediate ultrasonic examination may verify the tentative diagnosis. The usual therapy is then laparotomy with attempted surgical haemorrhage control. A conservative clinical haemorrhage control attempt is possible in exceptional cases only. Patients developing a HELLP syndrome although otherwise in seemingly perfect health, require closely meshed monitoring to exclude hepatic rupture.