Surgical management for subcapsular hematoma of the liver with preeclampsia: a case report

Surgical management for subcapsular hematoma of the liver with preeclampsia: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Surgical management for subcapsular hematoma of the liver with preeclampsia: a case report Guangyu Liu, Hongmei Yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7108560/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Subcapsular liver hematoma（SLH） of the liver is a rare but life- threatening complication of pregnancy. Early prevention ,early identification and multidisciplinary team cooperation management is very important.This paper describes a 37-year-old woman with preeclampsia and HELLP syndrome, who developed a grade III SLH that was managed cesarean section with Laparoscopic removal of subcapsular hematoma. Subcapsular liver hematoma HELLP syndrome preeclampsia Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction Subcapsular liver hematoma(SLH)is Spontaneous hematomaan in pregnancy and which is often associated with preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome and may lead to liver rupture.HELLP is considered to belong to the disease spectrum of preeclampsia, and occurs in 10–20% of those with severe preeclampsia Subcapsular[ 1 ]. liver hematoma (SLH) has been reported in less than 2% of pregnancies complicated by HELLP syndrome[ 2 – 4 ],and the maternal mortality is between 17% and 59% [4 5].The right liver lobe is more frequently affected in subcapsular hematomas[ 10 ]. 2. Case Report A 37-year-old woman with six pregnancies and zero births.This pregnancy was achieved in vitro fertilization-embryo transfer (IVF). The patient had undergone laparoscopic myomectomy and laparoscopic nephrolithotomy. She had a history of four induced abortions and termination of pregnancy at 21 weeks of gestation due to premature rupture of membranes. Due to a history of multiple uterine surgeries and second-trimester pregnancy termination, laparoscopic cervical cerclage was performed before this embryo transfer. Because of advanced age, 75 mg aspirin was taken orally daily from the first trimester until 36 weeks of gestation to prevention of hypertensive disorders during pregnancy. During the entire pregnancy, blood pressure remained within the normal range. Urine protein tests were negative. However, the platelet count (PLT) changed dynamically: it was range from194×10⁹/L to 92×10⁹/L .Cesarean section was considered the appropriate mode of delivery after laparoscopic cervical cerclage. So at 39 weeks of gestation, the patient was admitted for elective cesarean section. When be hospitalized ,The initial blood pressure measured on admission was 166/106 mmHg, which decreased to 160/102 mmHg after rest. Urine routine analysis showed urine protein (++), Urinary protein to creatinine ratio is 2.02, quantification of urinary protein is 0.622g/24h. combined clinical findings and Laboratory tests is diagnosised severe preeclampsia. Immediately administer magnesium sulfate for antispasmodic treatment and nifedipine tablets for blood pressure reduction treatment and complete the necessary examinations.Abdominal ultrasound: No obvious organic lesions were found in the liver(Fig. 1 ), gallbladder, pancreas, or spleen. Urinary ultrasound showed bilateral renal calculi, accompanied by left ureteral dilatation and left hydronephrosis.Ultrasonography of the thorax and abdomen: No peritoneal effusion was detected; dark, 0.6-cm fluid areas were seen in both pleural cavities.Cardiac ultrasound and Obstetrical ultrasound showed no abnormalities.The fetal heart rate was normal. Her blood investigations revealed a hemoglobin of 147g/L, platelets 97*10 9 /L, alanine aminotransferase (ALT) 18µ/L aspartate aminotransferase (AST)22µ/L.After treatment, the patient's blood pressure decreased significantly to 128/85 mmHg and then remained relatively stable, fluctuating between 109–128/63–86 mmHg.Before surgery, the patient experienced sudden right upper abdominal pain without nausea, vomiting, or other accompanying symptoms. She was immediately sent to the operating room for cesarean section. During the operation, about 1000 ml of dark red non-clotting blood was found in the abdominal cavity. The fetus was rapidly delivered, weighing 3610 g, with Apgar scores of 10 at 1, 5, and 10 minutes. The uterus was carefully examined during the operation, and no rupture was found. After suturing the uterine incision, the bilateral adnexa and pelvic cavity were explored, revealing no obvious abnormalities. Further palpation of the upper abdomen revealed swelling of the left lateral lobe of the liver.At the same time ,we initiate a consultation to gastrointestinal surgeons assist in the treatment. Laparoscopic exploration was performed. During the operation, about 100 ml of dark red blood was found accumulated in the splenic area, and the diaphragmatic surface of the liver was covered with a hematoma. There was a 4 cm × 2 cm rupture in the liver capsule of segment Ⅲ of the liver(Fig. 2 ), accompanied by active bleeding, with the deepest part of the rupture reaching 3 cm. Subsequently, a subcapsular hematoma evacuation of the liver was carried out,Place the abdominal drainage tube on the upper abdomen. After the operation, the patient was transferred to the intensive care unit for continued treatment of depression blood pressure, antispasmodic treatment, strengthening uterine contractions, preventing infection and preventing deep vein thrombosis in the lower limbs. On the second day after the operation, when the condition was stable, the patient was transferred back to the ward. On the fifth day after the operation, the patient was discharged. During the hospitalization, we observed some Laboratory results were worsen within 17 h after cesarean section.the patient's liver function test results trended upwards to a maximum of 221U/L for AST and of 229 U/L for ALT, Platelet count reached a minimum of 68*10 9 /L, Hemoglobin count reached a minimum of 89*10 9 /L,and other results, No significant changes were observed in the other results(Table 1 ). Table 1 Laboratory values Reference range Priorto induction During operation Delivery + 2h Delivery + 17h Postpartum day 2 Postpartum day 5 Leukocytes 3.5–9.5*10 9 /L 6.7 6.6 9.1 7.3 7.7 5.9 Hemoglobin 115-150g/L 147 104 111 89 99 103 Hematocrit 35–45% 42.8 30.9 34 26.8 30 30.3 Platelet 125–350*10 9 /L 97 72 69 68 104 199 ALT < 49U/L 18 116 222 229 65 30 AST < 40U/L 22 96 194 221 134 68 LDH 120-246U/L 178 219 381 389 315 292 UricAcid 184-420umol/L 553 517 483 586 497 444 Creatinine 30.4–70 umol/L 59 55 47 64 51 52 PT 7.2-13.2s 11 11.5 11.2 11.1 11 APTT 17.7-37.7s 25 24.8 23.8 28.2 24.7 INR 0.8-1.5s 1.0 1.05 1.02 1.02 1.0 Fibrinogen 200-400mg/dl 492 340 358 716 615 ALT: Alanine transaminase ; AST:Aspartate aminotransferase;LDH:Lactate dehydrogenase;PT: Prothrombin time;APTT: Activated partial thromboplastin time; INR: International normalized ratio. At 5 days after cesarean section, a follow-up transabdominal ultrasound was performed and showed the size of hepatic hematoma was 6.1*1.6cm(Fig. 3 ). All laboratory indicators have basically returned to normal, the patient had basically recovered clinically and biologically and hospital discharge. At her 3-months postpartum visit, the hepatic hematoma was slowly decreasing in size to a maximum of 3.6cm in length(Fig. 4 ). 3. Discussion Subcapsular hepatic hematoma represents a rare but life-threatening manifestation of HELLP syndrome. In our situation, From 2010 to the end of 2024, the total number of deliveries was 200,805, among which there were 295 cases of HELLP syndrome, and only one case developed subcapsular hematoma of the liver.The clinical presentation of hepatic subcapsular hematoma typically manifests as right upper abdominal pain, frequently accompanied by nausea and vomiting[ 6 , 11 ]. Ultrasound or computed tomography (CT) can be used to assist in fast diagnosis. In cases of non-ruptured hematomas, conservative management with close hemodynamic monitoring, serial imaging surveillance, blood product resuscitation, even hepatic artery embolization can be considered[ 7 – 8 ].For patients with suspected rupture of subcapsular hematoma of the liver, especially those with unstable hemodynamics, emergency surgical intervention by a multidisciplinary team is required[ 9 ].There are no established clinical guidelines for the management of hepatic subcapsular hematoma. A multidisciplinary team is needed to conduct a comprehensive assessment based on multiple aspects such as the gestational age at which the disease occurs, whether it is before or after delivery, hemodynamic conditions, and whether there is rupture and bleeding[ 10 – 11 ]. In our case, during the cesarean section, a large amount of blood accumulation in the abdominal cavity was found, and the tension of the liver capsule in the left liver lobe was palpated to increase. The patient's vital signs were still stable. Therefore, after discussing with the liver surgeon, laparoscopic exploration was performed, and the bleeding was successfully stopped. The overall treatment outcome of this patient was good. The surgical wound was small, and the postoperative recovery was fast. Furthermore, all postoperative monitoring parameters demonstrated minimal fluctuations and rapid normalization within clinically expected ranges. This case establishes a novel surgical paradigm for managing incidentally detected hepatic subcapsular hematoma rupture during cesarean delivery. In conclusion, the early identification of subcapsular hematoma of the liver is of great significance, and its treatment requires a comprehensive assessment of the treatment plan by a multidisciplinary team. Declarations Acknowledgements None. Authors’ contributions All authors read and approved the final manuscripte. Guangyu Liu reviewed the medical record，prepared figures 2，prepared the table and wrote the manuscripte .Hongmei Yang prepared figures 1，3 ，4 and supervised the whole study,and reevised the manuscripte for important intellectual content. Funding None. Availability of data and materials Not applicable as no data was used in this article. Ethics approval and consent to participate Not Applicable. Consent for publication The patient gave their permission for publication of this case report. Conflict of interest The authors have no conflicts of interest relevant to this article. References Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy Child birth 2009;9:8. Westengaard L., Spontaneous rupture of the liver in pregnancy, Acta Obstet Gynecology . (1983) 59, 559–561. Tamimi AA, Alawad AA. Large spontaneous subcapsular hematoma of the liver: a rare case report. Pan Afr Med J. 2019;32:16. Karateke A, Silfeler D, Karateke F, Kurt R, Guler A, Kartal I. HELLP syndrome complicated by subcapsular hematoma of liver: a case report and review of the literature. Case Rep Obstet Gynecol. 2014;2014: 585672. doi: 10.1155/2014/585672 . Bradke D, Tran A, Ambarus T, Nazir M, Markowski M, Juusela A. Grade III subcapsular liver hematoma secondary to HELLP syndrome: a case report of conservative management. Case Rep Womens Health. 2020;25:e00169. Westbrook R H, Dusheiko G, Williamson C .Pregnancy and liver disease[J].Journal of Hepatology, 2016, 64(4):933–945. Chahine, Khalil M. MD; Shepherd, Megan C. MD; Sibai, Baha M. MD. Association of Subcapsular Liver Hematoma With Preeclampsia, Eclampsia, or Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome. Obstetrics & Gynecology 145(3):p 335–342, March 2025. .Luhning K, MacCormick H, Macaulay B, Saunders M, Craig C. Subcapsular hepatic hematoma as a complication of severe preeclampsia: a case report. J Med Case Rep. 2021;15(1):625. Marinelli A, Hill J. Management of Ruptured Subcapsular Liver Hematoma as a Result of Hemolysis, Elevated Liver Enzyme, and Low Platelet Syndrome in a Rural Facility. Cureus. 2023;15(1):e33852. Ditisheim A, Sibai B M. Diagnosis and management of HELLP syndrome complicated by liver hematoma. Clin Obstet Gynecol. 2017;60:190–197. Liu J, Liu L, Liao G, Yao L. Conservative Treatment of Huge Hepatic Subcapsular Hematoma Complicated with Hepatic Infarction after Cesarean Section Caused by HELLP Syndrome - a Case Report and Literature Review. Z Geburtshilfe Neonatol. 2023;227(3):219–226. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7108560","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":484455767,"identity":"4aef58b7-2fe6-4843-afff-58f1e6697e05","order_by":0,"name":"Guangyu Liu","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Guangyu","middleName":"","lastName":"Liu","suffix":""},{"id":484455768,"identity":"dd82006f-342a-4614-8dce-999dccd16beb","order_by":1,"name":"Hongmei Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYBACNmbmgw8+/vsvxy//+ABxWvjY25INZ7AxG0s2pCUQp0WO54yZNA8bc+KGAzkGRDpMIsdMgoeHDajlzMcbbxjs5HQbCGpJK7aQkOAxnnmwd7PlHIZkY7MDBLUkb7xhYCAh23eYd5s0D8OBxG2EtSQYSCQkGDA2HON5RqQWniNGEgcOJChOOMPDRqQWUCA3NhwwlpzBZmw5x4AIv8g3Mx98/LfhgBy/BPPDG28q7OQIakEBEjxERg2yFlJ1jIJRMApGwYgAAEZRQVasSv9DAAAAAElFTkSuQmCC","orcid":"","institution":"Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Hongmei","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2025-07-12 13:53:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7108560/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7108560/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86773856,"identity":"7386da9c-f19d-42c3-9f97-4755e5b6eb33","added_by":"auto","created_at":"2025-07-15 12:20:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":438853,"visible":true,"origin":"","legend":"\u003cp\u003eThe normal liver of Ultrasoundscan\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-7108560/v1/b605943679599788d1c786ed.png"},{"id":86773857,"identity":"3608875f-42af-490d-b427-6ac17ec60262","added_by":"auto","created_at":"2025-07-15 12:20:21","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":102522,"visible":true,"origin":"","legend":"\u003cp\u003eDuring the operation, blood was found accumulated in the splenic area, and the diaphragmatic surface of the liver was covered with a hematoma. There was a 4 cm × 2 cm rupture in the liver capsule of segment Ⅲ of the liver.\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7108560/v1/e7832cdc4af3f01cc9a63e61.jpg"},{"id":86775093,"identity":"8bc36ba9-b00a-4f0c-8778-7b8b4db8e50a","added_by":"auto","created_at":"2025-07-15 12:28:21","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1410016,"visible":true,"origin":"","legend":"\u003cp\u003eThe liver of Ultrasoundscan in Postpartum day 5\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-7108560/v1/e08fab26001d5f416fa37419.png"},{"id":86773859,"identity":"bdf85cdd-7b5a-4767-afa9-4e7de4c97927","added_by":"auto","created_at":"2025-07-15 12:20:21","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1950208,"visible":true,"origin":"","legend":"\u003cp\u003eThe liver of Ultrasoundscan in Postpartum 3 months\u003c/p\u003e","description":"","filename":"Fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-7108560/v1/81822076162958eb27514e43.png"},{"id":86935382,"identity":"f39c444b-1ee2-46b6-8ec0-1d87c483d8e2","added_by":"auto","created_at":"2025-07-17 10:38:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4024371,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7108560/v1/fbeef8ec-f0c8-4d3b-9bea-4fad6956ce7a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eSurgical management for subcapsular hematoma of the liver with preeclampsia: a case report\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSubcapsular liver hematoma(SLH)is Spontaneous hematomaan in pregnancy and which is often associated with preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome and may lead to liver rupture.HELLP is considered to belong to the disease spectrum of preeclampsia, and occurs in 10\u0026ndash;20% of those with severe preeclampsia Subcapsular[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. liver hematoma (SLH) has been reported in less than 2% of pregnancies complicated by HELLP syndrome[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e],and the maternal mortality is between 17% and 59% [4 5].The right liver lobe is more frequently affected in subcapsular hematomas[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e"},{"header":"2. Case Report","content":"\u003cp\u003eA 37-year-old woman with six pregnancies and zero births.This pregnancy was achieved in vitro fertilization-embryo transfer (IVF). The patient had undergone laparoscopic myomectomy and laparoscopic nephrolithotomy. She had a history of four induced abortions and termination of pregnancy at 21 weeks of gestation due to premature rupture of membranes. Due to a history of multiple uterine surgeries and second-trimester pregnancy termination, laparoscopic cervical cerclage was performed before this embryo transfer. Because of advanced age, 75 mg aspirin was taken orally daily from the first trimester until 36 weeks of gestation to prevention of hypertensive disorders during pregnancy. During the entire pregnancy, blood pressure remained within the normal range. Urine protein tests were negative. However, the platelet count (PLT) changed dynamically: it was range from194\u0026times;10⁹/L to 92\u0026times;10⁹/L .Cesarean section was considered the appropriate mode of delivery after laparoscopic cervical cerclage. So at 39 weeks of gestation, the patient was admitted for elective cesarean section. When be hospitalized ,The initial blood pressure measured on admission was 166/106 mmHg, which decreased to 160/102 mmHg after rest. Urine routine analysis showed urine protein (++), Urinary protein to creatinine ratio is 2.02, quantification of urinary protein is 0.622g/24h. combined clinical findings and Laboratory tests is diagnosised severe preeclampsia. Immediately administer magnesium sulfate for antispasmodic treatment and nifedipine tablets for blood pressure reduction treatment and complete the necessary examinations.Abdominal ultrasound: No obvious organic lesions were found in the liver(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), gallbladder, pancreas, or spleen. Urinary ultrasound showed bilateral renal calculi, accompanied by left ureteral dilatation and left hydronephrosis.Ultrasonography of the thorax and abdomen: No peritoneal effusion was detected; dark, 0.6-cm fluid areas were seen in both pleural cavities.Cardiac ultrasound and Obstetrical ultrasound showed no abnormalities.The fetal heart rate was normal. Her blood investigations revealed a hemoglobin of 147g/L, platelets 97*10\u003csup\u003e9\u003c/sup\u003e/L, alanine aminotransferase (ALT) 18\u0026micro;/L aspartate aminotransferase (AST)22\u0026micro;/L.After treatment, the patient's blood pressure decreased significantly to 128/85 mmHg and then remained relatively stable, fluctuating between 109\u0026ndash;128/63\u0026ndash;86 mmHg.Before surgery, the patient experienced sudden right upper abdominal pain without nausea, vomiting, or other accompanying symptoms. She was immediately sent to the operating room for cesarean section. During the operation, about 1000 ml of dark red non-clotting blood was found in the abdominal cavity. The fetus was rapidly delivered, weighing 3610 g, with Apgar scores of 10 at 1, 5, and 10 minutes. The uterus was carefully examined during the operation, and no rupture was found. After suturing the uterine incision, the bilateral adnexa and pelvic cavity were explored, revealing no obvious abnormalities. Further palpation of the upper abdomen revealed swelling of the left lateral lobe of the liver.At the same time ,we initiate a consultation to gastrointestinal surgeons assist in the treatment.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eLaparoscopic exploration was performed. During the operation, about 100 ml of dark red blood was found accumulated in the splenic area, and the diaphragmatic surface of the liver was covered with a hematoma. There was a 4 cm \u0026times; 2 cm rupture in the liver capsule of segment Ⅲ of the liver(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), accompanied by active bleeding, with the deepest part of the rupture reaching 3 cm. Subsequently, a subcapsular hematoma evacuation of the liver was carried out,Place the abdominal drainage tube on the upper abdomen.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAfter the operation, the patient was transferred to the intensive care unit for continued treatment of depression blood pressure, antispasmodic treatment, strengthening uterine contractions, preventing infection and preventing deep vein thrombosis in the lower limbs. On the second day after the operation, when the condition was stable, the patient was transferred back to the ward. On the fifth day after the operation, the patient was discharged. During the hospitalization, we observed some Laboratory results were worsen within 17 h after cesarean section.the patient's liver function test results trended upwards to a maximum of 221U/L for AST and of 229 U/L for ALT, Platelet count reached a minimum of 68*10\u003csup\u003e9\u003c/sup\u003e/L, Hemoglobin count reached a minimum of 89*10\u003csup\u003e9\u003c/sup\u003e/L,and other results, No significant changes were observed in the other results(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLaboratory values\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference range\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePriorto induction\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDuring\u003c/p\u003e\u003cp\u003eoperation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDelivery\u003c/p\u003e\u003cp\u003e+\u0026thinsp;2h\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDelivery\u0026thinsp;+\u0026thinsp;17h\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ePostpartum day 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePostpartum day 5\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeukocytes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.5\u0026ndash;9.5*10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e115-150g/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHematocrit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u0026ndash;45%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e26.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePlatelet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e125\u0026ndash;350*10\u003csup\u003e9\u003c/sup\u003e/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e199\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;49U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e222\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e229\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAST\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;40U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e194\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e221\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120-246U/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e219\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e381\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e389\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e315\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e292\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUricAcid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e184-420umol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e553\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e483\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e586\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e497\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e444\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCreatinine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.4\u0026ndash;70 umol/L\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.2-13.2s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e11.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAPTT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.7-37.7s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e28.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e24.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eINR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.8-1.5s\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFibrinogen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e200-400mg/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e492\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e340\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e716\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e615\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eALT: Alanine transaminase ; AST:Aspartate aminotransferase;LDH:Lactate dehydrogenase;PT: Prothrombin time;APTT: Activated partial thromboplastin time; INR: International normalized ratio.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAt 5 days after cesarean section, a follow-up transabdominal ultrasound was performed and showed the size of hepatic hematoma was 6.1*1.6cm(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). All laboratory indicators have basically returned to normal, the patient had basically recovered clinically and biologically and hospital discharge.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAt her 3-months postpartum visit, the hepatic hematoma was slowly decreasing in size to a maximum of 3.6cm in length(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eSubcapsular hepatic hematoma represents a rare but life-threatening manifestation of HELLP syndrome. In our situation, From 2010 to the end of 2024, the total number of deliveries was 200,805, among which there were 295 cases of HELLP syndrome, and only one case developed subcapsular hematoma of the liver.The clinical presentation of hepatic subcapsular hematoma typically manifests as right upper abdominal pain, frequently accompanied by nausea and vomiting[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Ultrasound or computed tomography (CT) can be used to assist in fast diagnosis.\u003c/p\u003e\u003cp\u003eIn cases of non-ruptured hematomas, conservative management with close hemodynamic monitoring, serial imaging surveillance, blood product resuscitation, even hepatic artery embolization can be considered[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].For patients with suspected rupture of subcapsular hematoma of the liver, especially those with unstable hemodynamics, emergency surgical intervention by a multidisciplinary team is required[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].There are no established clinical guidelines for the management of hepatic subcapsular hematoma. A multidisciplinary team is needed to conduct a comprehensive assessment based on multiple aspects such as the gestational age at which the disease occurs, whether it is before or after delivery, hemodynamic conditions, and whether there is rupture and bleeding[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our case, during the cesarean section, a large amount of blood accumulation in the abdominal cavity was found, and the tension of the liver capsule in the left liver lobe was palpated to increase. The patient's vital signs were still stable. Therefore, after discussing with the liver surgeon, laparoscopic exploration was performed, and the bleeding was successfully stopped. The overall treatment outcome of this patient was good. The surgical wound was small, and the postoperative recovery was fast. Furthermore, all postoperative monitoring parameters demonstrated minimal fluctuations and rapid normalization within clinically expected ranges. This case establishes a novel surgical paradigm for managing incidentally detected hepatic subcapsular hematoma rupture during cesarean delivery.\u003c/p\u003e\u003cp\u003eIn conclusion, the early identification of subcapsular hematoma of the liver is of great significance, and its treatment requires a comprehensive assessment of the treatment plan by a multidisciplinary team.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscripte. Guangyu Liu reviewed the medical record，prepared figures 2，prepared the table and wrote the manuscripte .Hongmei Yang prepared figures 1，3 ，4 and supervised the whole study,and reevised the manuscripte for important intellectual content.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eNot applicable as no data was used in this article.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eThe patient gave their permission for publication of this case report.\u003c/p\u003e\n\u003cp\u003eConflict of interest\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest relevant to this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHaram K, Svendsen E, Abildgaard U. The HELLP syndrome: clinical issues and management. A Review. BMC Pregnancy Child birth 2009;9:8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWestengaard L., Spontaneous rupture of the liver in pregnancy, \u003cem\u003eActa Obstet Gynecology\u003c/em\u003e. (1983) 59, 559\u0026ndash;561.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTamimi AA, Alawad AA. Large spontaneous subcapsular hematoma of the liver: a rare case report. Pan Afr Med J. 2019;32:16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarateke A, Silfeler D, Karateke F, Kurt R, Guler A, Kartal I. HELLP syndrome complicated by subcapsular hematoma of liver: a case report and review of the literature. Case Rep Obstet Gynecol. 2014;2014: 585672. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2014/585672\u003c/span\u003e\u003cspan address=\"10.1155/2014/585672\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBradke D, Tran A, Ambarus T, Nazir M, Markowski M, Juusela A. Grade III subcapsular liver hematoma secondary to HELLP syndrome: a case report of conservative management. Case Rep Womens Health. 2020;25:e00169.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWestbrook R H, Dusheiko G, Williamson C .Pregnancy and liver disease[J].Journal of Hepatology, 2016, 64(4):933\u0026ndash;945.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChahine, Khalil M. MD; Shepherd, Megan C. MD; Sibai, Baha M. MD. Association of Subcapsular Liver Hematoma With Preeclampsia, Eclampsia, or Hemolysis, Elevated Liver Enzymes, and Low Platelet Count Syndrome. Obstetrics \u0026amp; Gynecology 145(3):p 335\u0026ndash;342, March 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e.Luhning K, MacCormick H, Macaulay B, Saunders M, Craig C. Subcapsular hepatic hematoma as a complication of severe preeclampsia: a case report. J Med Case Rep. 2021;15(1):625.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarinelli A, Hill J. Management of Ruptured Subcapsular Liver Hematoma as a Result of Hemolysis, Elevated Liver Enzyme, and Low Platelet Syndrome in a Rural Facility. Cureus. 2023;15(1):e33852.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDitisheim A, Sibai B M. Diagnosis and management of HELLP syndrome complicated by liver hematoma. Clin Obstet Gynecol. 2017;60:190\u0026ndash;197.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu J, Liu L, Liao G, Yao L. Conservative Treatment of Huge Hepatic Subcapsular Hematoma Complicated with Hepatic Infarction after Cesarean Section Caused by HELLP Syndrome - a Case Report and Literature Review. Z Geburtshilfe Neonatol. 2023;227(3):219\u0026ndash;226.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Subcapsular liver hematoma, HELLP syndrome, preeclampsia","lastPublishedDoi":"10.21203/rs.3.rs-7108560/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7108560/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Subcapsular liver hematoma（SLH） of the liver is a rare but life- threatening complication of pregnancy. Early prevention ,early identification and multidisciplinary team cooperation management is very important.This paper describes a 37-year-old woman with preeclampsia and HELLP syndrome, who developed a grade III SLH that was managed cesarean section with Laparoscopic removal of subcapsular hematoma.","manuscriptTitle":"Surgical management for subcapsular hematoma of the liver with preeclampsia: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-15 12:20:16","doi":"10.21203/rs.3.rs-7108560/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3801269a-2227-42bb-9c6b-bf9a10eec44f","owner":[],"postedDate":"July 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-17T10:38:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-15 12:20:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7108560","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7108560","identity":"rs-7108560","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}