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Hypertensive disorders in pregnancy complicated by liver rupture or hematoma: a systematic review of 391 reported cases

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 duri...

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Autores principales: Augustin, Goran, Hadzic, Matija, Juras, Josip, Oreskovic, Slavko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9270816/
https://www.ncbi.nlm.nih.gov/pubmed/35804368
http://dx.doi.org/10.1186/s13017-022-00444-w
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author Augustin, Goran
Hadzic, Matija
Juras, Josip
Oreskovic, Slavko
author_facet Augustin, Goran
Hadzic, Matija
Juras, Josip
Oreskovic, Slavko
author_sort Augustin, Goran
collection PubMed
description 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 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13017-022-00444-w.
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spelling pubmed-92708162022-07-10 Hypertensive disorders in pregnancy complicated by liver rupture or hematoma: a systematic review of 391 reported cases Augustin, Goran Hadzic, Matija Juras, Josip Oreskovic, Slavko World J Emerg Surg Research 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 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13017-022-00444-w. BioMed Central 2022-07-08 /pmc/articles/PMC9270816/ /pubmed/35804368 http://dx.doi.org/10.1186/s13017-022-00444-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Augustin, Goran
Hadzic, Matija
Juras, Josip
Oreskovic, Slavko
Hypertensive disorders in pregnancy complicated by liver rupture or hematoma: a systematic review of 391 reported cases
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 Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9270816/
https://www.ncbi.nlm.nih.gov/pubmed/35804368
http://dx.doi.org/10.1186/s13017-022-00444-w
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