This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: JIPMER 2018, Subject name: Gynaecology & Obstetrics
A pregnant woman with HELLP syndrome suddenly developed hypotension, right hypochondriac pain, ascites, pleural effusion and sudden onset of breathlessness. What is your diagnosis? 
Select and explain. 
A. Abruption placentae, B. DIC, C. Rupture of hepatic hematoma, D. Pa of pre-eclamptic toxemia
C: Rupture of hepatic hematoma
Answer: C: Rupture of hepatic hematoma 
Explanation: Hepatic hematoma can develop in the absence of under lying pathology . the majority of cases in pregnancy occur in the presence of HELLP. HELLP syndrome associated with maternal morbidity including acute renal failure, hepatic hematoma, pulmonary edema, cerebral hemorrhage and DIC, subsequent pregnancies are infrequently complicated by HELLP. Unruptured hepatic hematoma are probably more common than clinically suspected and are more likely to be found with HELLP syndrome. The current management of hematoma usually consists of observation unless bleeding is ongoing.in rare cases liver transplantation is necessary.