A 25-year-old woman, 39 weeks pregnant, presented with interscapular pain.
During his stay in the emergency department he presented sudden hypotension (blood pressure 80/40 mmHg) and supraumbilical abdominal pain.
Complete blood count data and coagulation study: haemoglobin 10.2 g/dl, hematocrit 30.3%, platelets 23 x 103/μl; prothrombin activity 66%, APTT: 36.1 seconds and platelet count:
A cardiotocographic control was carried out and in view of the evidence of fetal bradycardia, an urgent cesarean section was indicated extra and a live male fetus (2,900 g).
The hemoperitoneum was evaluated by general surgery.
Medium laparatomy was aspirated and approximately 900 ml of blood was aspirated from the cavity. A large bilateral submandibular hepatic hematoma was found.
Two desgarments in the hepatic capsule (segment IVb and segment V 5 and 3 cm respectively) presented active bleeding that was controlled with packing maneuvers and placement of plaques of Tariched PharmaTM Switzerland ZNycom).
Preoperative analysis tables: haemoglobin 3.9 g/dl, haematocrit 11.5%, platelets: 17 x 103/μl, prothrombin activity: 72%, APTT: 32 seconds, GOT 1060 UDH/l
Two platelet concentrates and 7 units were transfused.
The patient was transferred to the ICU where two more concentrates were transfused, 700 ml of plasma and 7 units of platelets. Corticosteroid therapy (dexamethasone) was instituted and platelet counts returned to normal.
Assessment of haptoglobin showed hemolysis (1 mg/dl, normal 30-200 mg/dl).
On the fourth day he went to the ward and was discharged on the 16th day.
A subsequent CT scan showed a large subaortic hematoma without laceration or free fluid.
