Liver rupture is a rare life threatening complication of severe preeclampsia and Hemolysis Elevated Liver Enzymes and Low Platelets (HELLP Syndrome).  Occurring in one out of 225,000 pregnancies our institution has had three cases since July 2009.   Liver rupture presents a unique challenge to even the well seasoned experienced nurse. The Purpose of this presentation is to help nurses recognize the potential for liver rupture and empower them with the knowledge of nursing interventions needed to care for this emergency.

Case:

A 29 year old 27 week gestation patient arrives in OB triage with elevated blood pressures from her doctor’s office, trouble focusing and +2 proteinuria.  After evaluation she was admitted to the antenatal unit for further monitoring.  On day three she complained of severe epigastric pain and was transferred to OB High Risk.  General Surgery, Perinatology, Neonatology and Anesthesia were immediately consulted.  After intervention to treat her hypertension and review of the diagnostic and laboratory results, a decision was made to proceed with a cesarean delivery.

Post operatively liver enzymes became grossly elevated and she developed Disseminated Intravascular Coagulation (DIC) necessitating transfusion of blood products. Despite the transfusion, her condition continued to deteriorate and a collaborative decision was made to return the patient to the operating room (OR) for exploratory surgery.  A significant intraabdominal hemorrhage with subscapular hepatic hematoma rupture was found.  The patient’s recovery was complicated by the need for ventilator assistance, dialysis, interventional radiology and multiple trips back to the OR.

Following this tumultuous journey the patient was discharged after a lengthy twenty two day hospitalization with no long term sequelae.  If not for the multitude of dedicated healthcare team members and their individual contributions this patient may not have been successfully diagnosed and treated.

Conclusion:

Although liver rupture is a rare occurrence, nurses need to diligently monitor patients with HELLP syndrome for signs and symptoms of this catastrophic event.  Labor units can be better prepared to intervene by having specialized equipment immediately available. Clear communication among the healthcare team is essential to ensure a successful outcome.

Keywords: Liver Rupture, Collaboration, Interventions