Miguelote Rui Filipe, Costa Vera, Vivas José, Gonzaga Luís, Menezes Carlos Alpoim
Department of Obstetrics and Gynaecology, Alto Ave Hospital Center, Guimarães, Portugal.
Arch Gynecol Obstet. 2009 Jun;279(6):923-6. doi: 10.1007/s00404-008-0829-7. Epub 2008 Nov 1.
We report the case of a 28-year-old nulliparous woman who presented at 36 weeks' gestation with preeclampsia: high blood pressure, proteinuria and edema. Serum test results were normal and platelet count was 155 x 10(3)/mm(3). After 30 h the patient initiated severe epigastric pain and vomits, and lab tests presented a slight increase in liver enzymes. The platelet count remained above 150,000/microL. Cesarean section (CS) was performed. Six hours after CS, she developed a hypovolemic shock and lab tests became increasingly abnormal (liver enzymes increased sharply and hemoglobin and platelet count decreased sharply). Abdominal ultrasound showed suggestive signs of hepatic rupture. The patient was stabilized and exploratory laparotomy was performed. Perihepatic packing was applied. The patient was discharged after 25 days of admission (15 days at the ICU) and three explorative laparotomies. This case highlights the unpredictability of this event based on the changes of liver enzyme values, LDH and platelet count. These changes only occurred when the rupture had already occurred and the patient was in hypovolemic shock.
我们报告了一例28岁未生育女性的病例，该患者在妊娠36周时出现子痫前期：高血压、蛋白尿和水肿。血清检查结果正常，血小板计数为155×10³/mm³。30小时后，患者开始出现严重上腹部疼痛和呕吐，实验室检查显示肝酶略有升高。血小板计数仍高于150,000/μL。进行了剖宫产术（CS）。剖宫产术后6小时，她出现了低血容量性休克，实验室检查结果越来越异常（肝酶急剧升高，血红蛋白和血小板计数急剧下降）。腹部超声显示有肝破裂的提示性迹象。患者病情稳定后进行了剖腹探查术。采用了肝周填塞术。患者入院25天后（在重症监护病房15天），经过三次剖腹探查术后出院。该病例突出了基于肝酶值、乳酸脱氢酶（LDH）和血小板计数变化的这一事件的不可预测性。这些变化仅在破裂已经发生且患者处于低血容量性休克时才出现。
