Hypertensive disorders in pregnancy complicated by liver rupture or hematoma: a systematic review of 391 reported cases
Abstract Background Spontaneous liver rupture in pregnancy is often unrecognized, highly lethal, and not completely understood. The goal was to summarize and define the etiology, risk factors, clinical presentation, appropriate diagnostic methods, and therapeutic options for spontaneous hepatic rupt...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | World Journal of Emergency Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13017-022-00444-w |
| _version_ | 1828760085506031616 |
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| author | Goran Augustin Matija Hadzic Josip Juras Slavko Oreskovic |
| author_facet | Goran Augustin Matija Hadzic Josip Juras Slavko Oreskovic |
| author_sort | Goran Augustin |
| collection | DOAJ |
| description | Abstract Background Spontaneous liver rupture in pregnancy is often unrecognized, highly lethal, and not completely understood. The goal was to summarize and define the etiology, risk factors, clinical presentation, appropriate diagnostic methods, and therapeutic options for spontaneous hepatic rupture during pregnancy/puerperium (SHRP) complicated by the hypertensive disorder. Methods Literature search of all full-text articles included PubMed (1946–2021), PubMed Central (1900–2021), and Google Scholar. Case reports of a spontaneous hepatic rupture or liver hematoma during pregnancy or puerperium as a complication of hypertensive disorders (preeclampsia, eclampsia, HELLP syndrome) were searched. There was no restriction of language to collect the cases. Additional cases were identified by reviewing references of retrieved studies. PRISMA guidelines for the data extraction and quality assessment were applied. Results Three hundred and ninety-one cases were collected. The median maternal age was 31 (range 17–48) years; 36.6% were nulliparous. Most (83.4%) occurred in the third trimester. Maternal and fetal mortality was 22.1% and 37.2%, respectively. Maternal and fetal mortality was significantly higher 1) before the year 1990, 2) with maternal hemodynamic instability, and 3) eclampsia. The most important risk factors for SHRP were preeclampsia and HELLP syndrome. Most women had right lobe affected (70.9%), followed by both lobes in 22.1% and left lobe in 6.9%. The most common surgical procedure was liver packing. Liver transplantation was performed in 4.7% with 100% survival. Maternal mortality with liver embolization was 3.0%. Higher gestational age increases fetal survival. Conclusion The diagnosis and treatment of SHRP are often delayed, leading to high maternal and fetal mortality. SHRP should be excluded in hemodynamically unstable patients with preeclampsia/eclampsia or HELLP syndrome and right upper abdominal pain. Liver embolization and liver transplantation contribute to maternal survival. Maternal and fetal mortality was significantly higher before the year 1990. Hemodynamic instability, preeclampsia, and eclampsia have a significant negative influence on maternal survival. Level of evidence Level V |
| first_indexed | 2024-12-11T01:08:34Z |
| format | Article |
| id | doaj.art-42fd5caa16ed47f3b740551edb1c0292 |
| institution | Directory Open Access Journal |
| issn | 1749-7922 |
| language | English |
| last_indexed | 2024-12-11T01:08:34Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj.art-42fd5caa16ed47f3b740551edb1c02922022-12-22T01:26:07ZengBMCWorld Journal of Emergency Surgery1749-79222022-07-0117111210.1186/s13017-022-00444-wHypertensive disorders in pregnancy complicated by liver rupture or hematoma: a systematic review of 391 reported casesGoran Augustin0Matija Hadzic1Josip Juras2Slavko Oreskovic3Department of Surgery, University Hospital Centre Zagreb, School of Medicine University of ZagrebDepartment of Surgery, Clinical Hospital ‘’Sveti Duh’’Department of Surgery, University Hospital Centre Zagreb, School of Medicine University of ZagrebDepartment of Surgery, University Hospital Centre Zagreb, School of Medicine University of ZagrebAbstract Background Spontaneous liver rupture in pregnancy is often unrecognized, highly lethal, and not completely understood. The goal was to summarize and define the etiology, risk factors, clinical presentation, appropriate diagnostic methods, and therapeutic options for spontaneous hepatic rupture during pregnancy/puerperium (SHRP) complicated by the hypertensive disorder. Methods Literature search of all full-text articles included PubMed (1946–2021), PubMed Central (1900–2021), and Google Scholar. Case reports of a spontaneous hepatic rupture or liver hematoma during pregnancy or puerperium as a complication of hypertensive disorders (preeclampsia, eclampsia, HELLP syndrome) were searched. There was no restriction of language to collect the cases. Additional cases were identified by reviewing references of retrieved studies. PRISMA guidelines for the data extraction and quality assessment were applied. Results Three hundred and ninety-one cases were collected. The median maternal age was 31 (range 17–48) years; 36.6% were nulliparous. Most (83.4%) occurred in the third trimester. Maternal and fetal mortality was 22.1% and 37.2%, respectively. Maternal and fetal mortality was significantly higher 1) before the year 1990, 2) with maternal hemodynamic instability, and 3) eclampsia. The most important risk factors for SHRP were preeclampsia and HELLP syndrome. Most women had right lobe affected (70.9%), followed by both lobes in 22.1% and left lobe in 6.9%. The most common surgical procedure was liver packing. Liver transplantation was performed in 4.7% with 100% survival. Maternal mortality with liver embolization was 3.0%. Higher gestational age increases fetal survival. Conclusion The diagnosis and treatment of SHRP are often delayed, leading to high maternal and fetal mortality. SHRP should be excluded in hemodynamically unstable patients with preeclampsia/eclampsia or HELLP syndrome and right upper abdominal pain. Liver embolization and liver transplantation contribute to maternal survival. Maternal and fetal mortality was significantly higher before the year 1990. Hemodynamic instability, preeclampsia, and eclampsia have a significant negative influence on maternal survival. Level of evidence Level Vhttps://doi.org/10.1186/s13017-022-00444-wLiver hematomaLiver rupturePregnancyPuerperiumPreeclampsiaEclampsia |
| spellingShingle | Goran Augustin Matija Hadzic Josip Juras Slavko Oreskovic Hypertensive disorders in pregnancy complicated by liver rupture or hematoma: a systematic review of 391 reported cases World Journal of Emergency Surgery Liver hematoma Liver rupture Pregnancy Puerperium Preeclampsia Eclampsia |
| title | Hypertensive disorders in pregnancy complicated by liver rupture or hematoma: a systematic review of 391 reported cases |
| title_full | Hypertensive disorders in pregnancy complicated by liver rupture or hematoma: a systematic review of 391 reported cases |
| title_fullStr | Hypertensive disorders in pregnancy complicated by liver rupture or hematoma: a systematic review of 391 reported cases |
| title_full_unstemmed | Hypertensive disorders in pregnancy complicated by liver rupture or hematoma: a systematic review of 391 reported cases |
| title_short | Hypertensive disorders in pregnancy complicated by liver rupture or hematoma: a systematic review of 391 reported cases |
| title_sort | hypertensive disorders in pregnancy complicated by liver rupture or hematoma a systematic review of 391 reported cases |
| topic | Liver hematoma Liver rupture Pregnancy Puerperium Preeclampsia Eclampsia |
| url | https://doi.org/10.1186/s13017-022-00444-w |
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