title: [Spontaneous hepatic hematoma in twin pregnancy].
abstract: BACKGROUND
  The hepatic hematoma or rupture appear in 1 of every 100,000 pregnancies. The most common causes of hepatic hematoma in pregnancy are severe preeclampsia and HELLP syndrome; some predisposing factors are seizures, vomiting, labor, preexistent hepatic disease and trauma.
  
  
  METHODS
  A 33 year old primigravid with a normal 33 week twin pregnancy presented abdominal pain and hypovolemic shock due to spontaneous subcapsular hepatic hematoma; laparoscopy was performed to evaluate the possibility of rupture, which was not found, later emergency cesarean section was carried out followed by hepatic hematoma drainage and abdominal packaging by laparoscopy. After surgery the flow through drainage was too high additionally hemodynamic instability and consumption coagulopathy. Abdominal panangiography was performed without identifying bleeding areas. Intesive care was given to the patient evolving satisfactorily, was discharged 19 days after the event. Seven months later she had laparoscopic cholecystectomy due to acute litiasic colecistitis.
  
  
  CONCLUSIONS
  We found 5 cases in literatura about hepatic hematoma during pregnancy no related to hypertensive disorders of pregnancy; these were related to hepatoma, amebian hepatic abscess, falciform cell anemia, cocaine consumption and molar pregnancy.
  
  
  CONCLUSIONS
  Hepatics hematomas have high morbidity and mortality so is significant early diagnosis and multidisciplinary approach.
authors.affiliation: División de Ginecología y Obstetricia, Hospital Angeles Lomas, Estado de México.
authors.forename: Carlos
authors.initials: C
authors.lastname: Quesnel
authors.forename: Alejandro
authors.initials: A
authors.lastname: Weber
authors.forename: Dalila
authors.initials: D
authors.lastname: Mendoza
authors.forename: Denzil
authors.initials: D
authors.lastname: Garteiz
mesh_terms: D000328:Adult; D005260:Female; D006406:Hematoma / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000628:therapy; D011247:Pregnancy; D059285:Pregnancy, Twin