Hepatic rupture in pregnancy

A report describes a case of a 24-year-old primigravida who presented at 34+1 weeks' gestation with abdominal pain of 24 hours. She also reported feeling less fetal movements for the past two hours and a history of typhoid at 28 weeks of gestation. 

An ultrasound scan revealed an absence of fetal heartbeat and the presence of heterogeneous collection in the sub-hepatic region. However, placental abruption was not present. 

An emergency exploratory laparotomy was conducted, and a dead fetus was delivered by cesarean section. Nearly 1.6 L of haemoperitoneum was seen in the peritoneal cavity. The right lobe of the liver showed active bleeding originating from the subcapsular region. The liver appeared swollen, making direct hemostasis challenging. Since dislodging the existent clot might risk hemorrhage, the surgeons attempted perihepatic packing using hemostatic sponges to compress the actively bleeding site.

The patient recieved intravenous fluid administration, oxygen inhalation, repeated blood transfusion and broad-spectrum antibiotic coverage. patient received a discharge in stable physical state after 18 days.

Runwal S, Kulshreshtha S. Hepatic Rupture In Near-Term Pregnancy: A Hullabaloo Amidst The Usual Course. Indian Obstetrics and Gynecology. 2023;13(4).