Spontaneous Liver Rupture In Pregnancy Associated With Severe DIC: Management Of The Coagulation Disorder Prior To Surgery

Spontaneous rupture of the liver is a severe com plication of pregnancy (maternal mortality: 59%, fetal mortality: 77%). The etiology is unknown, but it is commonly agreed that pre-ecclamptic toxaemia, and vascular damage of the liver play a definite role. Severe coagulation abnormalities which have been previously observed in these patients have as yet not been studied extensively. Recently we investigated two patients witn spontaneous liver rupture during pregnancy. Case 1: 34 year old multipara was presented with abdominal pain in the 37th wk of gestation. Suddenly a state of shock was observed. Surgery revealed hemoperi- toneum, subcapsular haematoma of the liver and ruptured capsule. The patient survived. Case 2: 30 year old primipara 37 wk of gestation was admitted with severe abdominal pain, jaundice and shock. Autopsy revealed a large subcapsular haematoma with ruptured capsule. Coagulation studies at admission revealed extensive DIC.

Bleeding and DIC were succesfully controlled by the following transfusion regimen: 1) purified human AT III concentrates 2) prothrombin complex 3) cryoprecipitate 4) low dose heparin 5) platelets 6) Fresh Frozen Plasma 7) packed cells.

Conclusively, maternal mortality might be reduced by early recognition of symptoms followed by prompt surgical intervention after correction of shock and coagulation defects.