Characteristics and treatment of hepatic rupture caused by HELLP syndrome Ana C. P. F. Araujo, MD, PhD, a,b Marcos D. Leao, MD, b Maria H. Nobrega, MD, PhD, a,b Patricia F. M. Bezerra, MD, a,b Flavio V. M. Pereira, MD, b Edailna M. M. Dantas, MD, b George D. Azevedo, MD, PhD, b,c Selma M. B. Jeronimo, MD, PhD b,d, * Department of Gynecology and Obstetrics, a Health Graduating Program, Health Sciences Center, b Departments of Morphology c and Biochemistry, d Bioscience Center, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil Received for publication September 9, 2005; revised November 22, 2005; accepted January 10, 2006 KEY WORDS Hepatic rupture HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome Preeclampsia Hepatic artery ligation Objective: The purpose of this study was to review the management of hepatic rupture caused by HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome and to assess maternal and perinatal outcomes of these cases. Study design: A retrospective study of HELLP syndrome cases that were complicated by hepatic rupture was conducted. Results: Ten cases of hepatic rupture were identified. The median maternal age was 42.5 G 5.9 years (median G SD), and the median gestational age at delivery was 35.5 G 4.9 weeks. The most frequent signs and symptoms of hepatic rupture were the sudden onset of abdominal pain, acute anemia, and hypotension. Laboratory findings included low platelet count and increased hepatic enzymes. Surgery was performed in 9 cases. One case was treated nonsurgically. The maternal mortality rate was 10%, and the perinatal mortality rate was 80%. Conclusion: A combination of surgical treatment with hepatic artery ligation and omental patch- ing with supportive measures was effective in decreasing the mortality rate in hepatic rupture caused by HELLP syndrome. Ó 2006 Mosby, Inc. All rights reserved. Spontaneous hepatic rupture is a rare, but life- threatening, complication of preeclampsia that fre- quently is associated with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. 1 Dur- ing pregnancy, the incidence of spontaneous hepatic rupture is reported to be between 1 in 45,000 and 1 in 225,000 overall deliveries. 1-3 The most common clinical signs of hepatic rupture are right upper quadrant or epigastric pain, severe right shoulder pain, nausea, vom- iting, abdominal distention, and hypovolemic shock. 4 The successful management of hepatic rupture has involved a combination of surgical intervention and aggressive supportive care. Several surgical approaches have considerably decreased the morbidity and mortal- ity rates that are associated with this entity, 1 but there is still not an agreement on the best approach to treat this severe complication of pregnancy. * Reprint requests: Selma M. B. Jeronimo, Department of Bio- chemistry, Universidade Federal do Rio Grande do Norte, CP 1624, Natal, RN, 59078-970, Brazil. E-mail: smbj@cb.ufrn.br 0002-9378/$ - see front matter Ó 2006 Mosby, Inc. All rights reserved. doi:10.1016/j.ajog.2006.01.016 American Journal of Obstetrics and Gynecology (2006) 195, 129–33 www.ajog.org