Fatal Rupture of Subcapsular Hepatic Hematoma in Preeclampsia with Severe Features: A Catastrophic Obstetric Emergency

Abstract

Background: Subcapsular hepatic hematoma in pregnancy is a rare complication, and it’s a life-threatening complication associated with severe preeclampsia and HELLP syndrome. Subcapsular hepatic hematoma complicates approximately 1 in 40,000 and 1 in 250,000 pregnancies.  Timely identification and interdisciplinary management are essential for improving maternal outcomes. Management approach is multidisciplinary treatment options range from conservative treatment to surgical modalities, including hepatic resection, hepatic artery ligation, and liver transplantation, depending on hemodynamic stability and trauma severity. Case: We present a case of a 25-year-old gravida 3 para 2 at gestational age 32+6 weeks with severe preeclampsia who developed sudden epigastric pain and hypovolemic shock. A trans abdominal ultrasound revealed intrauterine fetal demise and a large right-lobe Subcapsular hepatic hematoma with hemoperitoneum. Management: An emergency laparotomy revealed a ruptured Subcapsular hematoma affecting over 60% of the liver surface. Primary hemostasis was accomplished using Feliciano perihepatic packing. Despite all intensive resuscitation measures and re-exploration. Outcome: The patient ultimately succumbed to hemorrhagic shock and multiple organ failure. This case outlines the importance of early identification, diligent observation, and prompt multidisciplinary intervention in severe maternal hypertension aggravating hypertensive disorder in pregnancy, especially in severe preeclampsia. Subcapsular hepatic hematoma is a critical yet preventable contributor to maternal mortality linked to severe preeclampsia. Careful clinical assessment, timely imaging, and swift surgical intervention are crucial for improving survival rates. This example underscores the necessity of prompt identification, swift resuscitation, interdisciplinary collaboration, and availability of modern surgical methods to enhance outcomes in this rare yet severe condition.