Rinehart B K, Terrone D A, Magann E F, Martin R W, May W L, Martin J N
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA.
Obstet Gynecol Surv. 1999 Mar;54(3):196-202. doi: 10.1097/00006254-199903000-00024.
This article is a critical review of the obstetric literature concerning preeclampsia-associated hepatic hemorrhage to develop guidelines conducive to optimal maternal and perinatal outcomes. An English literature search was performed for reports of hepatic hemorrhage or hepatic rupture in pregnancy during 1960 to 1997. Data were analyzed by Statmost packages using ANOVA, Chi-square, and Fisher's exact tests. One hundred forty-one patients with hepatic rupture/hemorrhage were reported. The three most common presenting findings were epigastric pain, hypertension, and shock. With rare exception, patients had evidence of preeclampsia. Diagnosis was elusive and most frequently accomplished at laparotomy. When utilized, ultrasound and computed tomography (CT) were helpful diagnostic modalities. Maternal survival was highest in the arterial embolization treatment group. Maternal and perinatal survival improved considerably during the study interval. Route of delivery did not seem to impact survival rates. It was concluded that the application of ultrasound and CT for diagnosis and the use of hepatic artery embolization for treatment of hepatic hemorrhage/rupture seem to be beneficial management options for this rare event.
本文是一篇关于子痫前期相关肝出血的产科文献综述，旨在制定有助于实现最佳母婴结局的指南。对1960年至1997年期间妊娠合并肝出血或肝破裂的报告进行了英文文献检索。使用方差分析、卡方检验和费舍尔精确检验，通过Statmost软件包对数据进行分析。共报告了141例肝破裂/出血患者。最常见的三个表现是上腹部疼痛、高血压和休克。除极少数例外，患者均有子痫前期的证据。诊断很困难，大多数情况下是在剖腹手术时确诊。超声和计算机断层扫描（CT）在使用时是有用的诊断方法。动脉栓塞治疗组的孕产妇存活率最高。在研究期间，母婴存活率有了显著提高。分娩方式似乎不影响存活率。得出的结论是，应用超声和CT进行诊断以及使用肝动脉栓塞治疗肝出血/破裂似乎是处理这一罕见事件的有益管理选择。
