Improving survival with liver rupture complicating pregnancy

The reported maternal mortality of 59% that results from rupture of the liver in pregnancy is probably excessive if modern diagnostic and treatment techniques are fully utilized. The rarity and variable presentation should not lead to an incorrect diagnosis and possible fatal outcome. Pregnant patients or patients who recently have undergone delivery, especially those with hypertension, who complain of epigastric and/or discomfort in the right upper quadrant of the abdomen should be considered to be candidates for rupture of the liver. Ultrasound, which is generally available, is an adequate diagnostic technique in most patients. Computed tomography and technetium scanning are helpful tools. Ligation of specific bleeding points, compression, deep hepatic sutures, omental pedicles, topical agents, ligation of the hepatic artery, hepatic artery embolization, and other techniques should be used prior to performance of lobectomy. Drainage is recommended. Replacement of blood, correction of coagulation defects, monitoring of respiratory function, and attention to known postoperative complications should improve the outcome of patients with this serious complication.