Preeclampsia-Associated Hepatic Hemorrhage and Rupture: Mode of Management Related to Maternal and Perinatal Outcome

This article is a critical review of the obstetric literature concerning preeclampsia-associated hepatic hemorrhage to develop guidelines conductive to optimal maternal and perinatal outcomes. An English literature search was performed for reports of hepatic hemorrhage or hepatic rupture in pregnancy during 1960 to 1997. Data were analyzed by Statmost packages using ANOVA, Chi-square, and Fisher's exact tests. One hundred forty-one patients with hepatic rupture/hemorrhage were reported. The three most common presenting findings were epigastric pain, hypertension, and shock. With rare exception, patients had evidence of preeclampsia. Diagnosis was elusive and most frequently accomplished at laparotomy. When utilized, ultrasound and computed tomography (CT) were helpful diagnostic modalities. Maternal survival was highest in the arterial embolization treatment group. Maternal and perinatal survival improved considerably during the study interval. Route of delivery did not seem to impact survival rates. It was concluded that the application of ultrasound and CT for diagnosis and the use of hepatic artery embolization for treatment of hepatic hemorrhage/rupture seem to be beneficial management options for this rare event. TARGET AUDIENCEObstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVESAfter completion of this article, the reader will be able to understand the pathophysiology of hepatic hemorrhage, including the incidence of the condition, presenting signs and symptoms, and other associated conditions; to be aware of all the diagnostic tests available and all the therapeutic options for hepatic hemorrhage; and to understand the perinatal and maternal mortality of this condition.