Hizkiyahu Ranit, Rabinovich Anat, Thachil Jecko, Sheiner Eyal, Shaked Gad, Sebbag Gilbert, Maymon Eli, Erez Offer
a Department of Obstetrics and Gynecology "B" , Soroka University Medical Center, Ben-Gurion University of the Negev , Be'er Sheva , Israel.
b Thrombosis and Hemostasis Unit , Hematology Institute, Soroka University Medical Center , Be'er Sheva , Israel.
J Matern Fetal Neonatal Med. 2019 Aug;32(15):2517-2523. doi: 10.1080/14767058.2018.1439469. Epub 2018 Feb 21.
Liver rupture and hematoma are rare life-threatening complications of pregnancy. The aims of the current study are to: (1) characterize in a population-based study all cases of liver hematoma and/or rupture; and (2) validate the utility of the International Society on Thrombosis and Haemostasis (ISTH) modified pregnancy specific disseminated intravascular coagulation (DIC) score in those cases.
A retrospective cohort study including all patients with liver subcapsular hematoma or rupture between the years 1996 and 2012 was conducted. Information on maternal characteristics, clinical presentation, diagnostic studies, therapeutic modalities, as well as maternal and fetal outcomes was collected. The pregnancy-specific modified ISTH DIC scores were calculated from admission to discharge, a score >26 is suggestive of DIC.
Out of 175,000 births in our database, seven patients were identified with liver rupture or subcapsular hematoma, representing a prevalence of 4:100,000 deliveries. Of those, six had liver rupture and one had subcapsular liver hematoma. One patient died of hemorrhagic shock. Four patients underwent surgical liver packing and one also underwent hepatic artery ligation. Four out of seven patients were diagnosed during the immediate postpartum period with severe features of preeclampsia or with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Modified ISTH pregnancy-specific DIC scores were calculated for five out of seven patients, and three (60%) had a score higher than 26. Patients with higher scores received more blood product transfusions, had longer hospitalizations, and their neonates had lower 1 and 5 minutes Apgar scores.
Elevated pregnancy-specific modified ISTH DIC score (>26) in patients with liver hematoma or rupture was associated with adverse maternal and neonatal outcomes and appeared to perform well in distinguishing high and low-risk cases. Postpartum preeclampsia may be associated with severe features and a more complicated disease course.
肝破裂和肝血肿是妊娠罕见的危及生命的并发症。本研究的目的是：（1）在一项基于人群的研究中描述所有肝血肿和/或破裂病例的特征；（2）验证国际血栓与止血学会（ISTH）改良的妊娠特异性弥散性血管内凝血（DIC）评分在这些病例中的效用。
进行了一项回顾性队列研究，纳入1996年至2012年间所有患有肝包膜下血肿或破裂的患者。收集了产妇特征、临床表现、诊断检查、治疗方式以及母婴结局等信息。从入院到出院计算妊娠特异性改良ISTH DIC评分，评分>26提示存在DIC。
在我们数据库的175,000例分娩中，有7例患者被诊断为肝破裂或肝包膜下血肿，发生率为4:100,000次分娩。其中，6例为肝破裂，1例为肝包膜下血肿。1例患者死于失血性休克。4例患者接受了肝脏填塞手术，1例还接受了肝动脉结扎术。7例患者中有4例在产后立即被诊断为重度子痫前期或伴有溶血、肝酶升高和血小板减少（HELLP）综合征。7例患者中有5例计算了改良ISTH妊娠特异性DIC评分，其中3例（60%）评分高于26。评分较高的患者接受了更多的血液制品输注，住院时间更长，其新生儿1分钟和5分钟阿氏评分更低。
肝血肿或破裂患者妊娠特异性改良ISTH DIC评分升高（>26）与不良母婴结局相关，且在区分高危和低危病例方面表现良好。产后子痫前期可能伴有严重特征和更复杂的病程。
