Spontaneous rupture of the liver in pregnancy.

A case of spontaneous rupture of the liver in pregnancy, fatal to mother and child, is described. The patient, a multiparous, 36-year-old diabetic, presented in the 27th week of pregnancy with upper abdominal pains resembling biliary dyskinesia. After 8 hours' observation in the hospital she suddenly developed hypovolaemic shock and fetal heart tones disappeared. On acute cesarean section a dead fetus was delivered. Hemoperiteoneum was present, arising from a huge subcapsular hematoma of the right lobe of the liver, with rupture of Glisson's capsule. The hematoma was evaluated and tears in the liver parenchyma sutured. Disseminated intravasal coagulation complicated the early postoperative cause. A bacterial infection supervened later and the patient died in a septic stage on the 19th postoperative day. The literature is reviewed, and it is pointed out that greater awareness of the diagnosis could lead to better timing of surgery and an improved prognosis for mother and child.