Korean J Leg Med.  2017 May;41(2):46-50. 10.7580/kjlm.2017.41.2.46.

Spontaneous Hepatic Rupture in a Pregnant Woman with Preeclampsia: An Autopsy Case

• Park JH
• Lee YS
• Oh YH
• Oh SM
• Kim HG
• Na JY

• KMID: 2379672
• DOI: http://doi.org/10.7580/kjlm.2017.41.2.46

Abstract

Spontaneous hepatic rupture, which is a complication of hypertension in pregnancy, is extremely rare. However, high maternal and perinatal mortality rates are observed. Several factors, namely, age over 30 years, multiparity, severe preeclampsia, or HELLP syndrome (a group of symptoms which include hemolytic anemia, hepatic enzyme increase, and thrombocytopenia), are associated with this condition. An autopsy case of a woman with twin pregnancy was studied. She was at 36 weeks of gestational age and suffered from the sudden development and rapid progression of hypertension. Moreover, she died because of spontaneous hepatic rupture despite an emergency operation. Autopsy revealed a capsular rupture of the right lobe of the liver with numerous blood clots and hypovolemic signs, such as weak postmortem lividity and palor of the skin and conjunctiva. A close examination of the trunk and liver for the classification of the cause of rupture and an assessment of medical history, such as preeclampsia, are needed during postmortem examination of pregnant women with hepatic rupture or her fetus. To the best of our knowledge, this fatal complication in pregnant women is not yet presented in postmortem examinations in Korea. Thus, we report the findings of this case to share the knowledge.

Keyword

Liver; Spontaneous rupture; Pregnancy-induced hypertension; Autopsy

MeSH Terms

Anemia, Hemolytic
Autopsy*
Classification
Conjunctiva
Emergencies
Female
Fetus
Gestational Age
HELLP Syndrome
Humans
Hypertension
Hypertension, Pregnancy-Induced
Hypovolemia
Korea
Liver
Parity
Perinatal Mortality
Pre-Eclampsia*
Pregnancy
Pregnancy, Twin
Pregnant Women*
Rupture*
Rupture, Spontaneous
Skin

Figure

• 

  Fig. 1. (A, B) Hepatic capsular rupture with blood clots in the diaphragmatic side of the right lobe of liver was observed. (C) Based on the cut section of the liver, the parenchyma showed no specific abnormality, such as hemorrhage. (D) Upon histopathological examination of the liver, multifocal necrosis was revealed (H&E, ×40).

• 

  Fig. 2. (A, B) Uterus showed no specific abnormality, such as retained placenta or perforation.

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