Liver hemorrhage: recurrent episodes during pregnancy complicated by preeclampsia

Intrahepatic hemorrhage with rupture is the most serious and potentially life-threatening liver complication of pregnancy. With improved management, more patients are surviving this complication, and therefore, a number of patients are at risk of a recurrence should they again become pregnant. This case describes a patient who suffered two episodes of intrahepatic hemorrhage in two different pregnancies. Each episode was associated with mild preeclampsia. The first hemorrhage was limited by the liver capsule and treated conservatively, whereas with the second hemorrhage, the subcapsular hematoma ruptured, requiring arterial embolization followed by surgery. An arteriogram performed during the second episode of hemorrhage showed numerous pseudoaneurysms in the area of bleeding, suggesting that a vasculopathy plays a primary role in the pathogenesis of the intrahepatic hemorrhage associated with pregnancy. This case shows that intrahepatic hemorrhage may recur with future pregnancies, and individuals who suffer this complication of pregnancy and again become pregnant should be carefully monitored for the development of preeclampsia.