A pregnant woman admitted with pre eclampsia complicated with HELLP syndrome. She suddenly developed hypotension, breathlessness and right hypochondriac pain. USG showed hemoperitoneum. Most probable diagnosis is?: (A) Abruptio placentae, (B) DIC, (C) Rupture of hepatic hematoma, (D) Pa of pre-eclamptic toxemia
Answer is C. Peripoal hemorrhagic necrosis (characteristic hepatic lesion in pre eclampsia)in the liver periphery with some degree of hepatic infarction accompanied with hemorrhage Clinical presentation: moderate to severe right-upper quadrant or midepigastric pain hepatic region tenderness. raised liver enzymes, hemolysis and thrombocytopenia( HELLP Syndrome) hemorrhagic infarct may form a subcapsular hematoma which may rupture leading to sudden hypotension, breathlessness, hemoperitoneum.