Weemhoff R A, van Loon A J, Aarnoudse J G
Martini Ziekenhuis, afd. Gynaecologie en Obstetrie, Groningen.
Ned Tijdschr Geneeskd. 1996 Oct 26;140(43):2140-2.
A 31-year-old primigravida with pre-existent hypertension was admitted at 28.5 weeks gestation with foetal growth retardation. On the third day after admission she developed a 'haemolysis, elevated liver enzymes and low platelets' (HELLP) syndrome with severe pain in the epigastrium. Intrauterine death had occurred and abruptio placentae was suspected. Induction of labour was started with intravenous prostaglandins. The next day the haemoglobin concentration had decreased despite transfusions of red blood cell concentrates. At ultrasound examination, free fluid was detected in the abdomen and at explorative laparotomy a subcapsular liver haematoma appeared to have ruptured. An intrahepatic haematoma does not require operative treatment, unless it has ruptured. Packing of the ruptured liver with gauze and later removal of the gauze is preferable to lobectomy.
一名31岁的初产妇，孕前患有高血压，孕28.5周时因胎儿生长受限入院。入院后第三天，她出现了“溶血、肝酶升高和血小板减少”（HELLP）综合征，伴有上腹部剧痛。已发生宫内死亡，怀疑胎盘早剥。开始静脉滴注前列腺素引产。第二天，尽管输注了浓缩红细胞，但血红蛋白浓度仍下降。超声检查发现腹腔内有游离液体，剖腹探查时发现肝包膜下血肿似乎已破裂。肝内血肿除非破裂，否则不需要手术治疗。用纱布填塞破裂的肝脏，随后取出纱布，比肝叶切除术更可取。
