Spontaneous hepatic hemorrhage associated with pregnancy. Treatment by hepatic arterial interruption.

Abstract

The authors determined the effectiveness of hepatic arterial interruption in treating patients with spontaneous hepatic hemorrhage associated with pregnancy. This rare syndrome frequently is seen with eclampsia/preeclampsia and is associated with high maternal mortality. The recommended treatment has been the use of local hemostatic measures. The authors reviewed their experience managing eight patients by hepatic arterial interruption. Operative hepatic artery ligation was the initial method of controlling hepatic hemorrhage in three patients. One patient recovered, a hepatic sequestrum developed in one, and one patient died. Three patients survived after hepatic arterial embolization, but a sequestrum developed in one. Two patients died when hepatic arterial interruption was used after failed local hemostatic measures. The authors believe that hepatic arterial interruption is the preferred treatment for spontaneous hepatic hemorrhage associated with pregnancy. If the diagnosis is made at the time of cesarean section delivery, operative hepatic arterial ligation is indicated. If the diagnosis is made postpartum, percutaneous angiographic embolization should be performed.