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Spontaneous rupture of the liver in an uncomplicated pregnancy
1Department of Obstetrics and Gynecology, Kagoshima City Hospital, Japan.
Spontaneous liver rupture has been reported during pregnancy secondary to severe pregnancy-induced hypertension, eclampsia or syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP). Here we report a case diagnosed using CO2 intra-arterial digital subtraction angiography in an uncomplicated pregnancy. A 33-year-old Chinese woman at 39 weeks' gestation underwent a second caesarean delivery. Her pregnancy course had been uneventful. In the immediate postpartum period, she developed clinical signs of hepatic infarction or hematoma. After a blood transfusion and the use of vasoactive agents, her hemodynamic condition became stable. A hepatic angiography was performed before an emergent laparotomy. CO2 intra-arterial digital subtraction angiography revealed a small extravasation that was not found by the conventional method using an ionized medium. This disease should be considered when there occur pain in the upper part of the abdomen and signs of hemorrhagic shock, even in the case of an uncomplicated pregnancy.
Spontaneous liver rupture has been reported during pregnancy secondary to severe pregnancy-induced hypertension, eclampsia or syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP). Here we report a case diagnosed using CO2 intra-arterial digital subtraction angiography in an uncomplicated pregnancy. A 33-year-old Chinese woman at 39 weeks' gestation underwent a second caesarean delivery. Her pregnancy course had been uneventful. In the immediate postpartum period, she developed clinical signs of hepatic infarction or hematoma. After a blood transfusion and the use of vasoactive agents, her hemodynamic condition became stable. A hepatic angiography was performed before an emergent laparotomy. CO2 intra-arterial digital subtraction angiography revealed a small extravasation that was not found by the conventional method using an ionized medium. This disease should be considered when there occur pain in the upper part of the abdomen and signs of hemorrhagic shock, even in the case of an uncomplicated pregnancy.