Department of Surgery, University Hospital Centre Zagreb, School of Medicine University of Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
School of Medicine, University of Zagreb, Šalata 2, 10000, Zagreb, Croatia.
World J Emerg Surg. 2022 Jul 8;17(1):40. doi: 10.1186/s13017-022-00444-w.
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.
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.
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.
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 V.
自发性肝破裂在妊娠中常被忽视，具有高度致命性，且尚未被完全了解。本研究旨在总结和定义妊娠/产褥期（SHRP）并发高血压疾病时自发性肝破裂（SHRP）的病因、危险因素、临床表现、合适的诊断方法和治疗选择。
检索了包含 PubMed（1946-2021）、PubMed Central（1900-2021）和 Google Scholar 的所有全文文章。检索了妊娠或产褥期（子痫前期、子痫、HELLP 综合征）并发高血压疾病时发生自发性肝破裂或肝血肿的病例报告。为了收集病例，没有语言限制。通过回顾检索研究的参考文献，确定了其他病例。应用 PRISMA 指南进行数据提取和质量评估。
共收集了 391 例病例。产妇的中位年龄为 31 岁（范围 17-48 岁）；36.6%为初产妇。大多数（83.4%）发生在孕晚期。母亲和胎儿的死亡率分别为 22.1%和 37.2%。1）1990 年以前，2）母体血流动力学不稳定，3）子痫，这 3 种情况的母婴死亡率显著更高。SHRP 的最重要的危险因素是子痫前期和 HELLP 综合征。大多数女性为右叶受累（70.9%），其次是双叶受累（22.1%）和左叶受累（6.9%）。最常见的手术方式是肝填塞。4.7%的患者进行了肝移植，存活率为 100%。肝栓塞的产妇死亡率为 3.0%。较高的胎龄可增加胎儿存活率。
SHRP 的诊断和治疗往往被延误，导致母婴死亡率较高。对于血流动力学不稳定的子痫前期/子痫或 HELLP 综合征合并右上腹痛的患者，应排除 SHRP。肝栓塞和肝移植有助于产妇存活。1990 年以前，母婴死亡率显著更高。血流动力学不稳定、子痫前期和子痫对产妇的生存有显著的负面影响。
5 级。
