Conclusion
Intrahepatic haemorrhages/infarctions develop in pre-eclampsia/HELLP syndrome, typically in the late third trimester or postpartum interval in 1 per 45,000-2 per 25,000 pregnancies with a maternal mortality of 50%. Associated factors include multiparity, advanced maternal age, simultaneous pre-eclampsia and Anti-Phospholipid Syndrome. Signs and symptoms appear before significant laboratory changes appear. Hepatic rupture and shock can occur rarely within 48 hours of symptom onset.
The differential diagnoses of intra hepatic infarction include intrahepatic abscess, acute fatty liver of pregnancy, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, ruptured hepatic adenoma, hepatocellular carcinoma and hemangioma.
Preservation of portal tracts helps in differentiating infarction from other causes of hypo-attenuating lesions in the liver. Laboratory findings include anemia, thrombocytopenia, leucocytosis, marked aminotransferase elevation and azotemia. Changes are typically found in right lobe. Treatment includes urgent delivery. Patients with infarct can be managed conservatively and transfused. They are at risk of intrahepatic infection.