An Unusual Medicolegal Case of 32-Year-Old Mother and Her 29-Week Fetus With Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome

Abstract

Forensic medicine experts are well aware of blunt abdominal trauma, which often lead to death because of serious internal organ injury with severe blood loss. Sometimes careful examination of such cases may reveal some other underlying conditions, such as an existing disease that had contributed to the death or life-threatening complications. Our article presents a rare case of spontaneous hepatic rupture and intraperitoneal hemorrhage in a 32-year-old primigravida and her 29-week fetus, which was a result of hemolysis, elevated liver enzymes, and low platelet count syndrome. The said syndrome is a life-threatening obstetric complication usually considered to be a variant or complication of pre-eclampsia, which is characterized by hemolysis with microangiopathy, elevated liver enzymes, and low platelet count.

Spontaneous hepatic haemorrhage after caesarean section in a patient with uraemia and superimposed preeclampsia: a case report

“…15 Hemodynamically unstable patients should be immediately given fluid and blood resuscitation, and surgical treatment. [16][17][18] However, surgical treatments, such as abdominal packing and liver lobectomy may lead to haemostatic failure, postoperative abdominal infection, liver dysfunction and secondary multiple organ failure, 19 so selective embolization of the hepatic artery or embolization of the arterial supply upstream of the haemorrhagic site are satisfactory therapies for hepatic arterial bleeding. 20 Embolization may effectively control bleeding, significantly improve the maternal survival rate and avoid additional trauma.…”

Rapidly progressing HELLP syndrome and massive liver destruction in a 22-year-old female pregnant with monochorionic diamniotic gemelli

“…Szeremeta et al described a patient with spontaneous hepatic rupture and intraperitoneal haemorrhage due to HELLP syndrome. It describes the seriousness of the syndrome with death of the fetus 13…”