HELLP syndrome, consisting of hemolysis, elevated liver enzymes, and low platelet count, is a rare complication of occurring in 10 to 20% of women with severe preeclampsia and in 0.2 to 0.6% of total pregnancies. Delivery is the only definitive treatment, with maternal condition usually improving in the postpartum period.

Hemoperitoneum in a woman with preeclampsia is very rare, usually secondary to hepatic hematoma with rupture. While the prevalence of intrahepatic hematoma in these women has been reported to be as high as 39%, capsular rupture is rare, occurring up to 12% in women with capsular hematoma, carrying with it high mortality for both the mother and fetus.

We report an unusual case of hemoperitoneum secondary to liver hematoma in severe preeclampsia in the postpartum period that was conservatively managed leading to good maternal outcome.

We report a case of postpartum onset of severe preeclampsia in a 25-year-old woman complicated by hepatic dysfunction with coagulopathy and hemoperitoneum. This was secondary to a contained subcapsular hematoma and was conservatively managed resulting in a good outcome.

Prompt recognition with careful clinical examination, laboratory investigations and imaging, supportive treatment, and early fetal delivery remain the cornerstone in the management. Although reaching the diagnosis was initially challenging in our case study, both mother and baby had a good outcome with an appropriate supportive treatment.

Most cases with liver hematomas may lead to hepatic rupture with hemodynamic instability, necessitating an aggressive operative approach. However, conservative management with close monitoring of hemodynamic status can be undertaken if the patient is hemodynamically stable with good outcome, as illustrated in this case.

Loh M, Kathirvel R. An Unusual Case of Severe Preeclampsia in the Postpartum Period with Hemoperitoneum. J South Asian Feder Obst Gynae 2017;9(4):363-366.