Transcatheter arterial embolization in postpartum HELLP syndrome: A case report

Introduction: Hemolysis, elevated liver enzyme levels, and low platelet count (HELLP) syndrome is a pregnancy-related clinical condition characterized by hemolysis, elevated liver enzymes, and thrombocytopenia, posing significant risks to maternal and fetal safety. Hepatic hematoma with spontaneous rupture and bleeding is a rare but severe complication of HELLP syndrome, with limited reports of hepatic artery intervention and embolization therapy. Presentation of case: We present the case of a 35-year-old pregnant woman who developed worsening pain under the xiphoid process the night following a cesarean section. Her blood pressure dropped from 189/110 mmHg to 90/60 mmHg within 40 min. Vaginal exploration revealed no blood flow, and subsequent laparotomy uncovered multiple small liver surface lacerations actively bleeding. Emergency transcatheter arterial embolization (TAE) was promptly performed, stabilizing her condition. She was discharged 37 days post-admission. Discussion: TAE plays an important role in the treatment of HELLP syndrome with spontaneous liver rupture, with characteristics of minimal trauma and good efficacy, but the evidence supporting this recommendation is somewhat limited. Conclusion: This case underscores TAE as a potentially effective and less invasive alternative to surgical interventions for managing HELLP syndrome with spontaneous liver rupture. Further research is needed to better clarify the safety and efficacy of TAE in the treatment of HELLP syndrome with spontaneous liver rupture.