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  • Title: [Hepatic Rupture as a Complication of Hypertensive Disease of Pregnancy Maternal and the HELLP Syndrome].
    Author: Juárez-Azpilcueta A, Motta-Martínez E, Montaño-Uzcanga A.
    Journal: Gac Med Mex; 2003; 139(3):276-80. PubMed ID: 12872421.
    Abstract:
    INTRODUCTION: Hepatic rupture/hemorrhage is a rare but very serious complication associated in most of the cases to pregnancy hypertensive disease. It is an important cause of mother fetal death. OBJECTIVE: Three patients from the Hospital General of Mexico City were evaluated considering clinical evolution and characteristics, therapeutic approach, and a review of the subject in the world literature. MATERIAL AND METHODS: Case 1. a 35 years-old female, with term pregnancy, eutocic delivery, starts presenting symptomatology in immediate postpartum, poor evolution without adequate response, diagnosis of death, sub-capsular hemorrhage. Case 2. a 38-year-old female with term pregnancy, delivers by cesarean operation secondary to AFS finding during surgery, sub-capsular hemorrhage, and right lobe lesion. Leaves hospital. Case 3. a 30-year-old female showing acute abdominal pain in epigastric region, delivery by cesarean operation secondary to PSP, finding during surgery hemorrhage of the Glisson capsule and right hepatic lobe diagnosis is HELLP syndrome, poor evolution, sudden death. COMMENTARY: Hepatic hemorrhage is a rare disorder when it represents an obstetric emergency, due to its elevated association with death for the mother and the fetus; its etiology remain uncertain. Specific symptoms could be established through identification of a triad; epigastric pain; hypotension without evident bleeding cause, and clinical data of hypertensive disease of pregnancy. Prognosis becomes considerably positive if diagnosis is established early; the mortality has diminished with the advent of interventional radiology techniques (selective arterial embolization).
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