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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Spontaneous subcapsular hepatic hematoma in pregnant patients
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Vol. 70. Issue 3.
Pages 169-177 (March 2023)
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Vol. 70. Issue 3.
Pages 169-177 (March 2023)
Review
Spontaneous subcapsular hepatic hematoma in pregnant patients
Hematoma hepático subcapsular espontáneo en gestantes
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4
A. Calvo
Corresponding author
albertscg92@gmail.com

Corresponding author.
, E. Monge, L. Bermejo, F. Palacio-Abizanda
Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Abstract

Spontaneous subcapsular hepatic hematoma (SSHH) with or without previous history of preeclampsia and/or HELLP syndrome represents a very rare pathological condition in pregnancy and postpartum, (1/45,000–1/225,000 pregnancies). Its importance for the anesthesiologist lays in its association with high morbidity and mortality for the mother (60–86%, 39%) and newborn (42%). After a high clinical suspicion, the certainty clinical diagnosis is settled by different imaging techniques. However, in most cases the diagnosis of SSHH is a casual intraoperative finding associated to a maternal or foetal compromise. Nowadays the obstetric and anaesthetic management of a SSHH is not standardized and depends on its integrity, hemodynamic stability and the gestational period when diagnosed. The possibility of an acute critic haemorrhage with necessity of massive transfusion, makes advisable to provide updated protocols for the treatment of obstetric hemorrhage, adapting them to the clinical peculiarities of these patients. After the acute phase, close attention should be kept on thromboembolic complications.

Keywords:
Hepatic hematoma
HELLP syndrome
Preeclampsia
Eclampsia
Gestation
Peripartum hemorrhage
Resumen

El hematoma hepático subcapsular espontáneo (HHSE) en gestantes, con o sin historia previa de preeclampsia, eclampsia y/o síndrome HELLP, es una patología poco frecuente durante la gestación y el puerperio (1/45.000-1/225.000 embarazos). Su importancia para el anestesiólogo radica en que asocia una elevada morbimortalidad materna (60–86% y 39%) y neonatal (42%). Tras la sospecha clínica, el diagnóstico de certeza se establece mediante diversas pruebas de imagen, sin embargo en la mayoría de los casos el diagnóstico del HHSE es un hallazgo casual intraoperatorio asociado a un compromiso materno o fetal. Hoy en día la actuación obstétrica y anestésica ante un HHSE no está estandarizada y depende de su integridad, la estabilidad hemodinámica materna, así como el periodo gestacional en el momento del diagnóstico. La posibilidad de una hemorragia aguda crítica con necesidad de transfusión masiva, hace recomendable disponer de protocolos actualizados del tratamiento de la hemorragia obstétrica, adecuándolos a las peculiaridades clínicas de estas pacientes. Tras la fase aguda se debe prestar atención a las complicaciones tromboembólicas.

Palabras clave:
Hematoma hepático
Síndrome HELLP
Preeclampsia
Eclampsia
Gestación
Hemorragia periparto

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