Hepatic rupture during pregnancy has a high rate of maternal and fetal mortality. Most cases occur as a complication of severe pregnancy-induced hypertension, and maternal survival has been highest in patients managed with conservative surgical therapy.
A woman in late pregnancy experienced hepatic rupture associated with cocaine use. She underwent emergency cesarean delivery and was treated with topical hemostatic agents, perihepatic packing, and hepatic artery embolization. Reexploration with perihepatic packing was performed three times during the first 48 hours after delivery to control hepatic hemorrhage. Vasopressor support, blood product replacement, and prolonged assisted ventilation were used, and the patient was discharged on hospital day 42.
Liver damage may result from the potent vasoconstrictor property of cocaine, leading to vasospasm and ischemia. Conservative surgical management of hepatic rupture and supportive measures resulted in maternal survival.(Obstet Gynecol 1993;82:687-9)