Calling All Obstetric Nurses: Be On the Look Out for Liver Rupture

Authors


Poster Presentation

Background

Liver rupture is a rare life threatening complication of severe preeclampsia and hemolysis elevated liver enzymes and low platelets syndrome. This syndrome occurs in one of 225,000 pregnancies, and 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 nursing interventions to care for patients experiencing this emergency.

Case

A 29-year-old 27-week gestation patient arrived in obstetric triage from her physician's office with elevated blood pressure, trouble focusing, and +2 proteinuria. After evaluation she was admitted to the antenatal unit for further monitoring. On day 3 she complained of severe epigastric pain and was transferred to the high-risk obstetric department. General surgery, perinatology, neonatology, and anesthesia representatives 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.

Postoperatively liver enzymes became grossly elevated and she developed disseminated intravascular coagulation 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 for exploratory surgery. A significant intra-abdominal 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 operating room. The patient was discharged after a lengthy 22-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.

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