Characteristics and treatment of hepatic rupture caused by HELLP syndrome

The purpose of this study was to review the management of hepatic rupture caused by HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome and to assess maternal and perinatal outcomes of these cases. A retrospective study of HELLP syndrome cases that were complicated by hepatic rupture was conducted. Ten cases of hepatic rupture were identified. The median maternal age was 42.5 ± 5.9 years (median ± SD), and the median gestational age at delivery was 35.5 ± 4.9 weeks. The most frequent signs and symptoms of hepatic rupture were the sudden onset of abdominal pain, acute anemia, and hypotension. Laboratory findings included low platelet count and increased hepatic enzymes. Surgery was performed in 9 cases. One case was treated nonsurgically. The maternal mortality rate was 10%, and the perinatal mortality rate was 80%. A combination of surgical treatment with hepatic artery ligation and omental patching with supportive measures was effective in decreasing the mortality rate in hepatic rupture caused by HELLP syndrome.