Hepatic hemorrhage and the HELLP syndrome: a surgeon's perspective

Hypertension-induced hepatic disease is a common cause of abdominal pain and liver function test abnormalities in the pregnant patient. Liver hemorrhage and rupture, in turn, are the most unusual and serious complications of preeclamptic/eclamptic or HELLP (Hemolysis Elevated Liver enzymes and Low Platelet count) associated disease. Should a liver hematoma be documented, management must be aggressive, with treatment of hypertension, correction of any coagulopathy, and prompt delivery of the child. Rupture remains a surgical emergency with control of bleeding based on trauma principles. Postoperative care is difficult, with a propensity toward multiple system organ failure. With an aggressive multidisciplinary approach to the management of these patients, mortality rates have been decreased by fifty per cent. Subsequent pregnancies appear to carry no increased risk of liver rupture over the general population but should be followed carefully by a high-risk obstetrician.