M.M. MINNULLIN¹, F.F. MINNULLINA¹, R.A. ZEFIROV², L.M. MUKHAMETZYANOVA²

 ¹Kazan Federal University, Kazan

²Republic Clinical Hospital, Kazan

³Kazan State Medical University, Kazan

 Contact details:

Mukhametzyanova L.M. — Research Assistant, obstetrician-gynecologist

Address: 138 Orenburgskiy trakt, Kazan, Russian Federation, 420012, tel.: +7-917-929-50-77, e-mail: mmm-liliya@yandex.ru

The pregnancies after the 28^th week of gestation have a formidable complication – preeclampsia, which can lead to the development of the HELLP syndrome if not timely diagnosed and treated. That leads to multiple organ failure with decompensation of the basic vital functions. In half of the cases the DIC syndrome and acute renal failure may develop; rather seldom, subcapsular haematoma of the liver develops, while the liver rupture can lead to extremely serious consequences for a pregnant woman or a woman in labor, up to fatal outcome. There is little information about the treatment tactics for that pathology. It is still unclear if the patients with a large subcapsular haematoma of the liver due to HELLP syndrome should be operated. The article presents a clinical case of conservative treatment of a patient with this complication.

Key words: HELLP-syndrome, subcapsular haematoma of the liver, preeclampsia.

REFERENCES

1. Baxter J.K., Weinstein L. HELLP syndrome: the state of the art. Obstet. Gynecol. Surv, 2004, no. 59 (12), rr. 838–845.
2. Barton J.R., Riely S.A., Adamec T.A. et al. Hepatic histopathologic condition does not correlate with laboratory abnormalities in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count. Am. J. Obstet. Gynecol, 1992, no. 167, rr. 1538–1543.
3. Ventskovskiy B.M., Zaporozhan V.N., Senchuk A.Ya. et al. Gestozy: rukovodstvo dlya vrachey [Gestosa: a guide for doctors]. Moscow: Izd. MIA, 2005.
4. Zil’ber A.P., Shifman E.M. Etyudy kriticheskoy meditsiny. T. 3. Akusherstvo glazami anesteziologa [Sketches of Critical Medicine. Vol. 3. Obstetrics through the eyes of an anesthesiologist]. Petrozavodsk: Izd. PGU, 1997.
5. Sibai B.M., Ramadan M.K., Usta I. et al. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome). Am. J. Obstet. Gynecol, 1993, no. 169, rr. 1000–1006.
6. Kelly J., Ryan D.J., O’Brien N., Kirwan W.O. Second trimester hepatic rupture in a 35 year old nulliparous woman with HELLP syndrome: a case report. Wld J. Emerg. Surg, 2009, vol. 4, p. 23.
7. Pliegos Perez A.R., Zavalas Soto J.O., Rodriguez B.R. et al. Spontaneous hepatic rupture of pregnancy. A report of four cases and medical literature review. Ginecol. Obstet. Mex, 2006, vol. 74, pp. 224–223.
8. Ionkin D.A., Ikramov R.Z., Vishnevskiy V.A., Kabanova T.I., Zhavoronkova O.I., Kovalenko Z.A. Spontaneous subcapsular hematoma of the liver in the presence of HELLP. Annaly khirurgicheskoy gepatologii, 2011, vol. 16, no. 3 (in Russ.).
9. Makatsariya A.D., Bitsadze V.O., Khizroeva D.Kh. HELLP syndrome. Akusherstvo, ginekologiya i reproduktsiya, 2014, no. 2, pp. 61–68 (in Russ.).