Hepatic subcapsular hemorrhage associated with pregnancy

A case of subcapsular hematoma with hemorrhage from the left lobe of the liver in a 37-year-old multiparous patient with toxemia is reported. Approximately 120 cases have been reported in the past, mostly in obstetric and gynecologic journals. The great majority of hematomas were in the right lobe. A triad of toxemia of pregnancy, right upper quadrant pain, and sudden hypotension has been described in these cases. The etiology of subcapsular hemorrhage in patients with toxemia is likely due to fibrin thrombi in hepatic arterioles and sinusoids with periportal hemorrhagic necrosis, since this has been observed in fatal cases. Presumably, subcapsular hemorrhage, once initiated, perpetuates itself to involve an entire lobe. The overall mortality rate in these patients remains at about 75%. Failure to recognize the syndrome and intervene surgically almost always results in death. The only hope for survival is laparotomy with prompt control of hemorrhage. Hepatic artery ligation to control hemorrhage should probably be avoided it is clear that toxemia is a generalized process that adversely affects hepatic reserve and that further compromise may not be tolerated.