Liver Hematoma Research Articles

Hypertensive disorders in pregnancy complicated by liver rupture or hematoma: a systematic review of 391 reported cases

BackgroundSpontaneous liver rupture in pregnancy is often unrecognized, highly lethal, and not completely understood. The goal was to summarize and define the etiology, risk factors, clinical presentation, appropriate diagnostic methods, and therapeutic options for spontaneous hepatic rupture during pregnancy/puerperium (SHRP) complicated by the hypertensive disorder.MethodsLiterature search of all full-text articles included PubMed (1946–2021), PubMed Central (1900–2021), and Google Scholar. Case reports of a spontaneous hepatic rupture or liver hematoma during pregnancy or puerperium as a complication of hypertensive disorders (preeclampsia, eclampsia, HELLP syndrome) were searched. There was no restriction of language to collect the cases. Additional cases were identified by reviewing references of retrieved studies. PRISMA guidelines for the data extraction and quality assessment were applied.ResultsThree hundred and ninety-one cases were collected. The median maternal age was 31 (range 17–48) years; 36.6% were nulliparous. Most (83.4%) occurred in the third trimester. Maternal and fetal mortality was 22.1% and 37.2%, respectively. Maternal and fetal mortality was significantly higher 1) before the year 1990, 2) with maternal hemodynamic instability, and 3) eclampsia. The most important risk factors for SHRP were preeclampsia and HELLP syndrome. Most women had right lobe affected (70.9%), followed by both lobes in 22.1% and left lobe in 6.9%. The most common surgical procedure was liver packing. Liver transplantation was performed in 4.7% with 100% survival. Maternal mortality with liver embolization was 3.0%. Higher gestational age increases fetal survival.ConclusionThe diagnosis and treatment of SHRP are often delayed, leading to high maternal and fetal mortality. SHRP should be excluded in hemodynamically unstable patients with preeclampsia/eclampsia or HELLP syndrome and right upper abdominal pain. Liver embolization and liver transplantation contribute to maternal survival. Maternal and fetal mortality was significantly higher before the year 1990. Hemodynamic instability, preeclampsia, and eclampsia have a significant negative influence on maternal survival.Level of evidenceLevel V

Malignant rhabdoid tumor of the liver in a middle-aged woman: a case report and literature review

BackgroundExtrarenal malignant rhabdoid tumor (EMRT) is a rare and high-mortality malignant tumor, which is more common in infants and rarely seen in adults. We firstly report a case of liver malignant rhabdoid tumor (MRT) with a loss of SMARCB1 gene (alias INI1, SNF5, BAF47) expression in a middle-aged woman, and preliminarily summarize the clinical characteristics and discuss its potential treatment of liver MRT by reviewing 55 cases reported in the past.Case presentationWe report a 40-year-old woman who was admitted to our hospital for right epigastric pain. Previously, the patient was treated with liver hematoma in another hospital until she came to our hospital for abdominal pain again. In our hospital, we performed surgical treatment on her and the pathology diagnosed EMRT with negative expression of SMARCB1. After surgery, the patient underwent genetic testing, but failed to screen for sensitive targeted or conventional chemotherapy drugs, and she did not receive further treatment. Due to lack of timely diagnosis and effective chemotherapy drugs, tumor recurrence and metastasis occurred one year after surgery. Then the patient chose traditional Chinese medicine for treatment. And the metastatic tumors had still progressed after one year of treatment, but the patient didn’t have obvious discomfort symptoms.ConclusionsLiver MRT is a highly aggressive tumor with high metastatic potential and poor prognosis. It lacks specific symptoms and signs and is easy to be ignored and misdiagnosed. The mortality rate is extremely high as there is no effective treatment. But most tumors are accompanied by SMARCB1 deficiency, which may offer new research directions for cancer therapeutics. For the present, early detection, early diagnosis and early resection remain the key to improve the prognosis of patients.

Hemangioma of the liver in newborns Hussy Paul (Zbl. F. Gyn. No. 1, 1933)

Hussy Paul (Zbl. F. Gyn. No. 1, 1933) within a short period of time observed three cases of liver hematomas in newborns, not having met them earlier, despite the fundamental dissection of all corpses of newborns without exception. In two cases, the mothers were elderly primiparas.

English

BACKGROUND Preclinical studies have shown a neuroprotective effect of albumin in acute ischemic stroke (AIS). Owing to the scarcity of clinical studies establishing the correlation of serum albumin levels and AIS, the present study was conducted using National institute of health stroke scale score (NIHSS). METHODS The present prospective observational study evaluated the association of serum albumin and NIHSS score at baseline, 1 week, 1 month and 3 months of admission in 18 participants aged 18 years or more admitted within 48 hours of AIS in Internal Medicine Department of Government Medical College, Trivandrum between 2019 and 2020. Participants with transient ischemic attack, atrial fibrillation, decompensated cirrhosis of liver, nephrotic syndrome, hypoalbuminemia, hypercholesterolemia, and intracranial hematoma were excluded. Institutional Ethics Committee approved the project and written informed consent was obtained from all study participants. Serum albumin was estimated using enzyme linked immunosorbent assay (ELISA) kit using standardized technique. Logistic regression was used to determine the association of albumin and NIHSS. Analysis was done using R and p < 0.05 was considered statistically significant. RESULTS The mean age of study participants was 60.2 (12.9) and 55.6 % participants were males. 11.1 %, 5.6 % and 22.2 % participants had history of ischemic stroke, chronic kidney disease, and coronary artery disease respectively. At baseline serum albumin was 3.5 (1) g/dL and NIHSS was 13.2 (9.3). Negative correlation between serum albumin and NIHSS scale at baseline (r = -0.873, p < 0.01), at one week (r = - 0.856 and p < 0.01), at one month (r = -0.856 and p < 0.01) and three months (r = - 0.856 and p < 0.01) was observed. CONCLUSIONS Lower serum albumin level was associated with severe neurological deficit and had worse outcomes in patients with acute ischemic stroke. Albumin can be used as an easy, inexpensive, rapid, and reliable tool in determining the prognosis of AIS. KEY WORDS Serum Albumin, Acute Ischemic Stroke, Outcome, Prognosis, NIHSS

Liver haematoma in pregnancy: A rare complication of HELLP syndrome

Liver haematoma complicating pregnancy with HELLP syndrome is a rare but life-threatening condition. Diagnosis requires a high index of suspicion. Here a case of liver haematoma is presented in a 29 years multigravida at 34 weeks of pregnancy. Initially hypertension was not revealed since she had presented in shock. She had presented with on and off epigastric pain for many days. In context of haemoperitoneum in ultrasound, emergency laparotomy was done and liver haematoma diagnosed intraoperatively. Haematoma was managed with packing and second look laparotomy was done to remove the packs. Haematoma gradually resolved over period of months.

Diagnostic Accuracy of CT Scans in Blunt Abdomical Trauma

Background and Aim: Blunt abdominal trauma may lead to a serious situation that necessitates prompt diagnosis and treatment. The intra-abdominal injury effective diagnosis is difficult in patient’s management in such cases. The present study aims to evaluate the diagnostic accuracy of computed tomography scans in active internal bleeding following abdominal trauma. Materials and Methods: This cross-sectional study was carried out on 84 blunt abdominal trauma patients in the Department of Radiology Hayatabad Medical Complex, Peshawar for duration of six months from January 2021 to June 2021. All the patients with no clinical manifestations underwent diagnostic CT scans. Those who had a positive CT scan underwent laparotomy. The remaining patients were monitored for 24 hours and were discharged in case of no serious issues. Demographic details, patient information, trauma mechanism, CT scan indications, and findings, and laparotomy results were recorded. Regarding injured organs, specificity, sensitivity, and diagnostic accuracy of CT scans were determined. For individual cases, CT scans specificity, sensitivity, and accuracy were calculated. SPSS version 20 was used for data analysis. Results: This study included 84 patients, out of which 73 (86.9%) were male and 11(13.1%) were female. Patients aged 20-40 years were more prevalent 47 (56%), followed by those aged over 40 years were 20 (23.8%) and 10 to 19 years old were 17 (20.2%). Liver and spleen injuries had the highest CT scan sensitivity of 87.5% and 96.7% respectively. On the other hand, The CT scan's specificity was high in the injured kidneys (94%) and retroperitoneal hematoma 97.3% compared to other organ’s injuries. The diagnostic accuracy of CT scans in the identification of liver, kidney injuries, spleen, and retroperitoneal hematoma injuries was 93.7%, 92.3%, 96.2%, and 92.3% respectively. Conclusion: Our study found that CT scans are capable of detecting a wide range of injuries. CT scans are exceptionally valuable for assessing blunt abdominal injuries with active internal bleeding patients Furthermore, CT investigation is quick and extensively accessible. CT can produce high-resolution images with MPR and scanning protocol. Keywords: Diagnostic Accuracy; Abdominal Trauma Injuries, Computed Tomography (CT)

976 Traumatic Damage to The Liver Capsule: An Unusual Cause of Small Bowel Obstruction

Abstract A 57-year-old man presented to the emergency department with severe abdominal pain. Three months prior to presentation, he had sustained blunt trauma to his right side whilst cycling but had not sought medical attention. On admission, a CT scan showed small bowel obstruction and he underwent an emergency laparotomy. Intraoperatively, a subcapsular liver haematoma was identified, with incarcerated, necrotic small bowel within the liver capsule. The patient underwent deroofing of the haematoma with an omental patch and a small bowel resection with primary anastomosis. Small bowel obstruction is a common presentation in A&E and is responsible for half of emergency laparotomies in the UK each year. Although hepatic haematomas are also a relatively common complication of blunt trauma to the abdomen, associated bowel herniation into the liver capsule is very unusual. We believe this is the first time such a case of small bowel obstruction has been reported in the literature and we discuss details of operative management and highlight key learning points.

CT-088: Tamoxifen: An Anti-Estrogen Effectively Controlling Osler-Weber-Rendu Disorder

Osler-Weber-Rendu disease (OWRD) is an uncommon autosomal dominant disorder affecting the blood vessels throughout the body leading to vascular dysplasia. Patients have a high tendency for bleeding. The prognosis is overall good, as long as bleeding is adequately controlled. Here we report the case of a 48-year-old male patient who was referred to our institution for blood transfusion incompatibility. History goes back to two years ago when he started complaining of severe periodic epistaxis and gingival bleeding. He received more than 20 units of packed red blood cells (PRBCs) over the past 2 years. His physical examination was pertinent for telangiectasia overlying the nostrils and the lips. While taking a further detailed history, he mentioned that his sister was diagnosed with a liver hematoma secondary to an arterio-venous malformation (AVM) which was treated with embolization. Laboratory work-up didn’t reveal any abnormality in primary nor secondary hemostasis (normal platelet count, no von Willebrand factor deficiency, normal PT/PTT/fibrinogen/factor XIII/bleeding time). Total body CT angiography was negative for any AVM. Consequently, the patient was diagnosed with OWRD based on epistaxis, telangiectasias and family history of a first-degree relative with OWRD. Genetic testing was not available. He received moisturizing topical therapies to humidify the nasal mucosa. Our main aim was to control the bleeding episodes in order to defer blood transfusions. Thus, he was started on oral tranexamic acid (TXA) 1 gram three times per day and tamoxifen 20 mg per day. He also received regular intravenous iron. The bleeding episodes became less frequent. It has been 1 year without any blood transfusion. He is continuing TXA, tamoxifen and intravenous iron replacement regularly. Clinicians must be aware of this rare genetic disorder. Early diagnosis leads to improvement of the patients’ quality of life by initiating a medical and supportive treatment. Tamoxifen appears to be an effective agent in minimizing the bleeding episodes due to Osler-Weber-Rendu disease.

Complicated Post-Partum HELLP Syndrome Causing Acute Renal Failure and a Spontaneous Acute Subdural Hematoma

HELLP syndrome is characterized by hemolysis, elevated liver enzymes, and thrombocytopenia. It is a devastating illness that typically occurs in the third trimester of gestation. We present a unique case of complicated post-partum HELLP syndrome.The patient was a 34-year-old Caucasian G1PO woman at 40 weeks’ gestational age who presented for induction of labor. She underwent successful vaginal delivery. However, postoperatively the patient developed HELLP syndrome complicated by acute renal failure. She was transferred to the intensive care unit, where her renal function continued to decline, ultimately necessitating hemodialysis. She subsequently spontaneously developed an acute subdural hematoma.Most cases of HELLP syndrome occur in the third trimester, whereas fewer manifest post-partum. The pathophysiology of HELLP syndrome is poorly understood. While the defining organ of injury in HELLP syndrome is the liver, both kidney injury and spontaneous subdural hematomas can occur, as seen in this patient. The gold standard therapy for HELLP syndrome is prompt delivery of the fetus.HELLP syndrome continues to be a serious constellation of symptoms that can affect women late in their gestational period. As illustrated in this case report, prompt diagnosis of HELLP syndrome and appropriate management is critical.

Субкапсулярная гематома печени: оперировать или нет?

The pregnancies after the 28th week of gestation have a formidable complication - preeclampsia, which can lead to the development of the HELLP syndrome if not timely diagnosed and treated. That leads to multiple organ failure with decompensation of the basic vital functions. In half of the cases the DIC syndrome and acute renal failure may develop; rather seldom, subcapsular haematoma of the liver develops, while the liver rupture can lead to extremely serious consequences for a pregnant woman or a woman in labor, up to fatal outcome. There is little information about the treatment tactics for that pathology. It is still unclear if the patients with a large subcapsular haematoma of the liver due to HELLP syndrome should be operated. The article presents a clinical case of conservative treatment of a patient with this complication.

Congenital factor XIII deficiency in Iraq: An 8-year single-center study

BACKGROUND: Congenital FXIII deficiency is a rare genetic bleeding disorder that is inherited in an autosomal recessive pattern with a frequency of 1/2 million individuals in the human population. Deficiency of FXIII is associated with significant bleeding disorders.AIMS: This study aimed to evaluate the demographic parameters, clinical presentations, and outcome of patients who were diagnosed with congenital factor XIII deficiency.SUBJECTS AND METHODS: A retrospective descriptive study of patients who were diagnosed with congenital FXIII deficiency over a period from August 2008 to August 2016 was conducted. The study included patients who were diagnosed by having bleeding tendency and normal standard coagulation tests (normal platelet count, normal prothrombin time; normal partial thromboplastin time, and normal bleeding time) and the diagnosis was confirmed by clot solubility test in 5M urea. The diagnosis was made in the Hemophilia Ward, Children Welfare Teaching Hospital, Medical City, Baghdad.RESULTS: There were 111 cases of other coagulation factors' deficiency (rare bleeding disorders) registered in the center, congenital FXIII deficiency represented 24 (22%) of them. Males represented 14 (58.3%) and females 10 (41.7%) of patients. Most of the patients (41.7%) had their symptoms during the 1st year of life. Positive consanguinity was found in 100% of patients and 14 (58.3%) patients had a family history of FXIII deficiency. Umbilical cord bleeding and gum bleeding were present in 37.5% and 20.8%, respectively, and they were the most common first presenting symptoms of FXIII-deficient patients, while muscle hematoma (28.5%) and joint bleeding (24.7%) were the most common presenting symptoms in follow-up visits. The majority of the patients (79.1%) did not develop complications, the complications were developed in 3 (12.4%) patients, which were intracranial bleeding in 2 (8.3%) patients and liver hematoma in 1 (4.1%) patient. One patient (4.1%) developed recurrent abortion and one patient (4.1%) developed hepatitis C. No death was reported during the study period.CONCLUSIONS: FXIII deficiency founded to be a more common rare bleeding disorder among Iraqi patients, with a high rate of consanguineous marriage. Umbilical cord bleeding and gum bleeding were the most common presenting symptoms for FXIII deficiency. There was a considerable delay in the diagnosis of FXIII deficiency in the majority of patients.

Spontaneous rupture of subcapsular liver hematoma in sudden onset severe preeclampsia

Spontaneous rupture of subcapsular liver hematoma in sudden onset severe preeclampsia

HELLP syndrome complicated by subcapsular liver hematoma

Abstract Rationale: Subcapsular liver hematoma (SLH) is a rare but potentially fatal complication of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. The SLH incidence rate is about 1% to 2% in patients with preeclampsia and HELLP syndrome. Patient concerns: A 28-year-old woman (gravida 3, parity 2) was admitted to the hospital at 26+1 gestation weeks because of upper abdominal discomfort of 2 weeks duration. Diagnoses: The patient was diagnosed with pre-eclampsia and HELLP syndrome. CT scan confirmed the presence of SLH. Interventions: The patient was treated with magnesium sulphate and Glucocorticoid was given for fetal lung maturation. But the blood pressure continued to rise. Cesarean section was performed, and a male infant was delivered with APGAR score 7. Outcomes: SLH resolved after the operation and the patient was discharged 6 days later. The newborn was discharged 1 month later from the intensive care. Lessons: HELLP syndrome complicated with SLH is a life-threatening condition for pregnant women and fetus. The decrease in blood volume due to bleeding can mask the underlying pre-eclampsia and delay the diagnosis and treatment.

SUBCAPSULAR LIVER HEMATOMA – A COMPLICATION AFTER LAPAROSCOPIC CHOLECISTECTOMY

Subcapsular liver haematoma is among the most severe complications after laparoscopic cholecistectomy, but occurs rarely. The hematoma is usually located around the right lobe of the liver (in 75% of patients). We report the case of a 71 year old patient who underwent laparoscopic cholecistectomy for acute colecistitis. Initial postoperative evolution was favorable. On postoperative day 3 patient presents intense abdominal pain and decreased hemoglobin. The CT shows subcapsular hepatic hematoma. Emergency surgery is performed for signs of hemorragic shock with evacuation of the hematoma and hemostasis. Postoperative evolution is good. There are several theories proposed for the occurance of a subcapsular hematoma of the liver after laparoscopic cholecistectomy. Among these, the presence of a hemangioma, the use of NSAIDs or low molecular weight heparin. No clear mecanism is known and the only clinical sign can be abdominal pain. This case reminds us that we must take abdominal pain seriously after cholecystectomy in order to identify severe complications that can occur, such as hepatic subcapsular hematoma.

S2448 Rare Occurrence of a Spontaneous Unruptured Subcapsular Liver Hematoma

S2448 Rare Occurrence of a Spontaneous Unruptured Subcapsular Liver Hematoma

S2733 A Curious Case of a Bleed Without a Cause

INTRODUCTION: Spontaneous subcapsular hematoma of the liver is usually associated with pregnancy, coagulopathy or liver lesion. We report a rare case of spontaneous subcapsular liver hematoma without any of the above risk factors. CASE DESCRIPTION/METHODS: A 59-year-old lady with a history of hypertension presented with sudden-onset in the right upper abdomen, right chest, shoulder and neck pain. She was otherwise hemodynamically stable other than being mildly hypertensive. Work-up for cardiac ischemia was negative. She was noted to have a low hemoglobin of 10.4 g/dl (prior baseline was 13.7 g/dL) and she had mild hepatocellular injury (ALT 32 IU/L, AST 31 IU/L). She underwent CT scan to rule out pulmonary embolism which incidentally revealed a large subcapsular liver hematoma. MRI abdomen confirmed a large lenticular shaped subscapular collection along the right lobe of the liver measuring approximately 12 × 4 × 16 cm. There was no focal hepatic lesion to explain the cause of bleeding. She did not recall any preceding trauma and there was no obvious trauma on exam. She was not taking any blood thinners. She admitted to inadvertently using oral contraceptives (OCP) for over 30 years for purely birth control purposes. The patient was admitted for observation and remained clinically stable over the next few days. At her 1-month follow-up, an office ultrasound showed that the size of the hematoma had decreased when compared to her prior ultrasound during her hospitalization (thickness from intercostal view decreased from 42 mm to 35 mm). At her 1-year follow-up, an MRI abdomen was repeated that showed a minimal residual hematoma and no discrete underlying lesion. DISCUSSION: Spontaneous subcapsular hematoma of the liver represents an accumulation of blood between the capsule of Glisson and the liver parenchyma, and is frequently located around the right lobe. If it ruptures into the peritoneum, it can be potentially fatal. Our case is unique in that none of the usual risk factors such as pregnancy, trauma, blood thinner use or underlying liver lesion were present. To our knowledge, there are very few similar case reports that describe spontaneous subcapsular hepatic hematoma. OCP use is generally associated with the development of hepatic adenoma, which can in turn cause spontaneous subcapsular hematoma. Theoretically, long-term OCP use in a post-menopausal hypertensive lady (such as in our case) may mimic the pathophysiology of pregnancy and independently lead to spontaneous subcapsular bleeding.Figure 1.: MRI showing large hepatic subcapsular hematoma and no focal lesion.Figure 2.: MRI showing nearly resolved hepatic subcapsular hematoma.

Polyarteritis Nodosa – Risk of Stopping Immunosuppressent and a Rare Fatal Complication

Background: Polyarteritis nodosa (PAN) is a systemic necrotising vasculitis which can cause multifocal aneurysms of visceral arteries, which may rupture causing haemorrhage, thrombosis, organ ischemia and infarction While the treatment of vasculitis requires long term use of immunosuppressive drugs, these patients are more prone for diseases like tuberculosis due to decreased cell mediated immunity. Case presentation: Hepatic involvement in PAN is not common and many of the fi ndings are occult. A 40 year old lady, a known case of polyarteritis nodosa on treatment with steroid and immuno-suppressants for the last 18 years, with history of multiple episodes of relapse of the vasculitis, and cyclophosphamide induced ovarian failure on hormone replacement therapy was diagnosed to be having sputum positive tuberculosis. She was initiated on anti-tuberculosis treatment. Vasculitis was on remission for the last 12 months. So Mycophenolate Mofetil was stopped as per the advice of the Rheumatologist. 14 days later she developed abdominal pain with dropping hemoglobin. CT angiography showed ruptured liver hematoma with hemoperitoneum and she succumbed to her illness. Conclusion: Spontaneous hepatic hemorrhage, probably due to a ruptured hepatic artery aneurysm is a rare complication which is reported, only a very few times in the literature so far. This case report throws light on the possible detrimental outcomes in stopping immunosuppressive drugs, especially in a patient with multiple episodes of relapse in the past, in the background of an ongoing infection like tuberculosis. Continuation of the immunosuppressive drugs need to be considered against it’s stoppage in high risk patients.

Large subcapsular hematoma of the liver due to faja corset: a rare case report

BackgroundSubcapsular hematoma of the liver is a potentially life-threatening but extremely rare condition. It is often caused by a blunt trauma or other predisposing conditions such as a liver tumor, intra-tumor hemorrhage, surgery, preeclampsia, liver biopsy, and hemodialysis. Predisposing causes of liver hematoma include its large size and proximity to fixed structures. To date, there have been no reported cases of subcapsular liver hematoma caused by tight clothing such as corsets. Our case report is about an extremely rare case of subcapsular hematoma of the liver caused by wearing a tight faja corset in a young healthy female.Case presentationA forty-five-year-old Spanish female without any underlying health problems presented with sudden onset epigastric and right upper quadrant abdominal pain after wearing a faja corset the night prior to the hospital presentation. CT abdomen was noted for subcapsular hematoma of the liver. Her symptoms persisted and repeat CT abdomen showing worsening of the liver hematoma. Patient had interventional radiology (IR) guided drainage and was subsequently discharged home.ConclusionsSubscapular liver hematomas need to be considered in patients presenting with acute onset abdominal pain after wearing certain tight clothing. The necessity of an early and accurate diagnosis is vital for management as hemodynamically stable patients can be managed conservatively. Our patient was managed with IR-guided aspiration drainage of the hematoma. Surgery can be considered a last resort in case of life-threatening hemodynamic instability, peritoneal signs, free abdominal fluid, and failure of arterial embolization. Our case highlights the importance of early recognition of traumatic subcapsular hematomas to prevent life-threatening complications.

38 Does Umbilical Venous Catheter tip position impact complication rates in neonates?

Abstract Background Umbilical venous catheter (UVC) insertion is a very common procedure in neonatal intensive care units (NICU). UVCs are placed in ideal position in only about 50% cases. It is common practice to secure UVC in low position in the event of failure to place in optimal position. However, little is known about the association between catheter tip position and UVC related complications in neonates. Objectives The primary objective was to examine the association between the UVC tip position and UVC related complications in neonates. Our secondary objective was to evaluate the association between timing of UVC insertion and complication rates. Design/Methods We performed a retrospective cohort study of all neonates who had UVC inserted in a tertiary NICU between January 2017 and December 2018. Neonates with major congenital or chromosomal anomalies, hydrops fetalis and prenatally diagnosed cardiac arrhythmias or pericardial effusion were excluded. Electronic medical records and medical charts were reviewed. The primary outcome was presence of any one of the following complications: cardiac (arrhythmias, pericardial effusion, intracardiac thrombosis), hepatic (liver hematoma, cystic fluid collection in the liver, liver abscess, portal vein thrombosis), catheter associated infection, and mechanical complications. We compared the complications rates based on UVC tip position as determined by thoraco-abdominal radiograph. Optimal UVC position was defined as catheter tip between T8-T10 vertebral levels; low position as below T10 and high position as above T8. We also examined the association between time at UVC insertion (i.e. early (<12 hours) versus late (≥12 hours) and the type of complications. Results Among the 589 neonates who had UVC inserted during the study period, 40 were excluded. Of 549 included, UVC tip was at optimal position in 267 (48.6%), low position in 248 (45.2%) and high position in 34 (6.2%) neonates. The mean gestational age and birth weight of the study cohort were 30.9 ± 5.1 weeks and 1712 ± 1035g respectively. The mean birth weight and gestational age were comparable among the three groups. The overall complication rate was 36/549 (6.5%). There were no significant differences in the overall complication rates between the three groups (Table 1). However, cardiac complications (arrhythmias) were more frequent in the high UVC group compared to the optimum position group (8.8% vs 0.37%, OR 10; 95% CI 1.84, 56.5). Among 549 neonates, 391 had early UVC insertion and 158 had late insertion of UVC. There was no significant difference in UVC related complications between early and late insertion of UVC (6.9 % versus 5.7%, OR 2.49; 95% CI 0.34, 17.8). Conclusion The UVC related complications were more frequent in infants with high UVC position and least among those with optimal UVC position; although not statistically significant, it may be clinically important. High UVC position was more frequently associated with cardiac complications. There was no difference in complication rates between early and late UVC insertion.

Diagnóstico y manejo del síndrome HELLP en un hospital peruano

Introducción. El síndrome HELLP está caracterizado por hemólisis, enzimas hepáticas elevadas y plaquetopenia. Es una de las complicaciones maternas más graves del embarazo, con cifras significativas de morbimortalidad materna y riesgo elevado de insuficiencia renal, hematoma hepático, coagulopatía intravascular diseminada, politransfusión. Objetivos. Describir la presentación clínica, diagnóstico, complicaciones y manejo de los casos con síndrome HELLP en un hospital peruano. Métodos. Estudio descriptivo, retrospectivo de los casos diagnosticados con síndrome de HELLP en un hospital peruano. Resultados. En 30 618 partos atendidos, se encontró 71 casos de síndrome HELLP, con incidencia de 0,23%. Fueron multíparas el 68%, con edad promedio de 33 años. El diagnóstico se confirmó durante el embarazo en 46% y en el puerperio en 54%. De las gestantes, 58% desarrolló síndrome HELLP antes de las 37 semanas. La morbilidad materna incluyó insuficiencia renal en 25%, hematoma hepático con o sin rotura en 11%, insuficiencia respiratoria en 7%, eclampsia en 6%. El 85% de las pacientes requirió transfusiones con hemoderivados y/o plaquetas. La mortalidad materna fue 3%. Conclusiones. En la población estudiada, el síndrome HELLP se presentó con morbilidad materna elevada. Las muertes se asociaron a hematoma hepático y eclampsia.