HEPATIC HEMORRHAGE AND THE HELLP-SYNDROME - A SURGEONS PERSPECTIVE

Hypertension-induce hepatic disease is a common cause of abdominal pai n and liver function test abnormalities in the pregnant patient. Liver hemorrhage and rupture, in turn, are the most unusual and serious com plications of preeclamptic/edamptic or HELLP (Hemolysis Elevated Liver enzymes and Low Platelet count) associated disease. Should a liver he matoma be documented, management must be aggressive, with treatment of hypertension, correction of any coagulopathy, and prompt delivery of the child. Rupture remains a surgical emergency with control of bleedi ng based on trauma principles. Postoperative care is difficult, with a propensity toward multiple system organ failure. With an aggressive m ultidisciplinary approach to the management of these patients, mortali ty rates have been decreased by fifty per cent. Subsequent pregnancies appear to carry no increased risk of liver rupture over the general p opulation but should be followed carefully by a high-risk obstetrician .