title: Hepatic rupture in hemolysis, elevated liver enzymes, low platelets syndrome.
abstract: OBJECTIVE
  Rupture of hepatic hematoma associated with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is a catastrophic complication of pregnancy. Maternal and fetal mortality rates are still high despite advances in diagnosis and treatment. We aimed to present our experience at two referral centers for hepatic disease and to compare it with cases from the literature.
  
  
  METHODS
  We reviewed nine cases that occurred over the past 6 years in our centers and made an extensive literature review covering the past 10 years. We reviewed and compared multiple outcomes for all these cases.
  
  
  RESULTS
  The median maternal age of our patients was 29 years (interquartile range 27-32). Embolization treatment was used with seven of nine (78%) of our patients compared with 5 of 88 (6%) in the literature (P<.001). Our maternal and fetal mortality rates were 0% (95% confidence interval [CI] 0-34%) and 30% (95% CI 7-65%), respectively, compared with 17% (95% CI 10-26%) and 38% (95% CI 31-52%]) from our review of the literature from 2000 to 2010.
  
  
  CONCLUSIONS
  The use of hepatic artery embolization to address hepatic rupture associated with HELLP syndrome may help minimize morbidity and maternal mortality.
authors.affiliation: Centre Hospitalier de l'Université de Montréal, Montreal, Quebéc, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Grand'Maison
authors.forename: Nadine
authors.initials: N
authors.lastname: Sauvé
authors.forename: Florence
authors.initials: F
authors.lastname: Weber
authors.forename: Michel
authors.initials: M
authors.lastname: Dagenais
authors.forename: Madeleine
authors.initials: M
authors.lastname: Durand
authors.forename: Michèle
authors.initials: M
authors.lastname: Mahone
mesh_terms: D000328:Adult; D001792:Blood Platelets; D004621:Embolization, Therapeutic; D005260:Female; D046689:Fetal Mortality; D017359:HELLP Syndrome / Q000628:therapy*; D006406:Hematoma / Q000150:complications*; D006461:Hemolysis; D006499:Hepatic Artery; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000628:therapy*; D008423:Maternal Age; D008428:Maternal Mortality; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis / Q000628:therapy*; D012422:Rupture, Spontaneous / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D055815:Young Adult