Liver Hematoma in Pregnancy: Challenges, Management Strategies, and Outcomes

Liver hematoma is a rare but devastating complication of pregnancy, associated mainly with hypertensive disorders of pregnancy. Subcapsular liver hematomas complicate between 1 in 40,000 and 1 in 250,000 pregnancies. The risk is significantly higher in women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, with an incidence of 0.9-1.6% in this subgroup. Clinically, the condition arises as a result of vasospasm in the hepatic microcirculation, triggered by an imbalance in angiogenic factors such as soluble fms-like tyrosine kinase-1 and vascular endothelial growth factor, leading to hepatic ischemia, infarction, and subsequent hematoma formation. The right hepatic lobe is most frequently affected, and symptoms are often vague and nonspecific, necessitating a high index of suspicion for diagnosis. Early diagnosis can be made through imaging with ultrasonography or computed tomography. Patients with liver hematomas need highly individualized care. Optimal management remains unknown; historically, cases were managed surgically, but more recent case series have demonstrated that close observation with blood product replacement and surveillance of the hematoma with imaging is also a reasonable approach for stable patients. Although there is potential for liver recovery in most cases; severe cases can result in irreversible damage and complications such as hepatic rupture and death.