A 36-year-old woman, in her fourth pregnancy, gestational age of 35+2 weeks, was admitted to the delivery room with elevated blood pressure, epigastric pain and laboratory findings presenting HELLP syndrome (platelets count 50K, elevated liver function test: AST/ALT 230/330).
An ultrasound examination in the delivery room showed: Figure 1. sub-capsular liver hematoma.
The patient was transferred to the operating room for urgent cesarean section.
After Rapid delivery of the fetus surgical exploration of the superior abdominal cavity revealed ruptured sub-capsular hematoma: Figure 2.
Surgical hemostats were placed followed by packing of the liver, administration of multiple blood products transfusion for hemodynamic stabilization of the patient.
Second look laparotomy after 48h, proved successful with no further bleeding.