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Hepatic ruptura associated with severe preeclampsia and hellp syndrome attended at the regional hospital of Cajamarca 2017
(Universidad Privada Norbert Wiener, 2024-04-26) García Sánchez, Jessica Josefina; Villalba Condo, Rosario del Pilar; Sanz Ramirez, Ana María
This is an observational, descriptive, retrospective study involving a systematic review of the clinical history of a case of hepatic rupture associated with severe preeclampsia managed at the Regional Hospital of Cajamarca, occurring on June 30, 2017. The study included personal, family, and pathological history, general and specific examination, diagnosis, auxiliary exams, obstetric management, complications including hepatic rupture, referral to the National Maternal Perinatal Institute, clinical evolution, and discharge. A review of the literature was also conducted on the case. Results: The clinical case presented involves a 32-year-old multigravida at 39 weeks of gestation who underwent a home vaginal delivery. During the immediate postpartum period, she developed postpartum hemorrhage and epigastric pain, leading to referral from the José Sabogal Health Center to the Regional Hospital of Cajamarca with a diagnosis of a 11-hour postpartum woman in hypovolemic shock. Laboratory results showed: hemoglobin 8.6 g%, platelets 184,000/mm³, TGO 564 UI/L, TGP 299 UI/L, coagulation time 8 seconds, bleeding time 4 minutes, and prothrombin time 21.3 seconds. Abdominal ultrasound revealed approximately 1500 cc of free peri-hepatic fluid. She underwent exploratory laparotomy and hepatic packing due to severe preeclampsia, HELLP syndrome, hepatic rupture, and massive hemoperitoneum. The intraoperative finding was a subcapsular hematoma involving nearly the entire right lobe and a rupture at segment VI of the liver. The patient received 7 units of packed red blood cells and 6 units of fresh frozen plasma after informed consent. On the second postoperative day, she experienced unfavorable progression and was referred to the National Maternal Perinatal Institute for continued high-complexity management in the ICU. The clinical evolution was favorable, and she was subsequently referred back to her original hospital for further care.