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61 Antiphospholipid antibody syndrome presenting as spontaneous hepatic rupture
  1. I Cunanan,
  2. A Corpuz,
  3. VP Sta Maria and
  4. PA Casem
  1. Ilocos Training and Regional Medical Centre, Internal Medicine, City of San Fernando, Philippines

Abstract

Background and aims Spontaneous hepatic rupture (SHR) is a rare peripartum complication and usually occurs among patients with pre-eclampsia, eclampsia or HELLP syndrome. We report a case of a 29 year old primigravid woman with fetal death in utero and spontaneous hepatic rupture secondary to undiagnosed Antiphospholipid Antibody Syndrome (APAS). Despite its uncommonness, a high index of suspicion for an autoimmune disease such as APAS to prevent maternal and fetal complications is recommended.

Presenting a 29 year old, primigravid of 32 weeks age of gestation was admitted due to epigastric pain, hypotension and decreased fetal movement. She delivered to a dead male neonate via Emergency Low Segment Transverse Caesarean Section. Hemoperitonium and active bleeding from the liver were noted intraoperatively.

Methods Patient was managed as spontaneous hepatic rupture. APAS was considered and diagnosed via the Revised SAPPORO Criteria. HELLP syndrome and pre-eclampsia were ruled out by clinical and laboratory parameters.

Table 1

Revised SAPPORO Classification criteris for the antiphospholipid antibody syndrome.

Results Hepatic packing with drainage and blood pressure control were done. Patient received Low Molecular Weight Heparin and Aspirin and improved after 13 days without bleeding.

Conclusions Spontaneous hepatic rupture is a rare, life-threatening presentation of APAS that warrants timely diagnosis and effective control of haemorrhage to prevent maternal and fetal mortality. Early initiation of anticoagulation is both safe and effective in preventing APAS complications. Aspirin should be initiated to prevent future thrombosis and pregnancy loss.

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