Subcapsular liver hematoma complicating HELLP syndrome: A case report and review of management strategies.

Subcapsular liver hematoma is a life-threatening complication of pregnancy. It is associated with preeclampsia and HELLP syndrome. We present the case of a 36-year-old Caucasian nulliparous woman who was diagnosed at 29 weeks and 6 days of gestation with mild preeclampsia. After brief hospitalization she was discharged. During a daily follow-up, at 31 weeks and 3 days of gestation, she complained of mild abdominal pain and blood tests revealed HELLP syndrome. The cervix was unripe. A healthy baby was delivered by emergency cesarean section. The following day, the patient complained of persistent abdominal pain, and at the same time the hepatic cytolysis worsened dramatically. A computed tomography (CT) scan revealed a significant subcapsular hematoma without any active bleeding or breach of Glisson's capsule. We treated the patient conservatively and she was discharged home 10 days after the diagnosis was made. The symptoms of subcapsular liver hematoma are non-specific. They include nausea, vomiting and epigastric pain, and pain in the right upper quadrant or shoulder. Biological analyses can show hepatic cytolysis, haemolysis and coagulation disorders. Medical imaging can confirm the diagnosis. The management of subscapular liver hematoma may depends on whether there is hemodynamic stability, active bleeding or breach of Glisson capsule's. If the patient is stable and in the absence of active bleeding, management should be purely symptomatic.

Laparoscopic sleeve gastrectomy and pregnancy outcomes: A systematic review.

Obesity is a chronic disease that presents a significant prevalence among women within childbearing age. Laparoscopic sleeve gastrectomy (LSG) is a widely used method for the treatment of obesity. Several studies have examined this operation's impact on pregnancy outcomes with contradictory results. The aim of this systematic review was to examine the maternal and neonatal outcomes following LSG. The electronic databases of MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus as well as grey literature from inception to December 2019 were systematically reviewed. Search strategy included the terms: "sleeve" "gastrectomy" and "pregnancy". Eligibility criteria were randomized control trials, cohort studies and case series that reported on women with LSG prior to conception and maternal and neonatal outcomes. A total of 406 distinct articles were identified with nine studies included in the systematic review. A cumulative statistical analysis reported a preoperative BMI of 43.6 ±â€¯5.0 kg/m2 while BMI at conception was 29.6 ±â€¯4.9 kg/m2. The average weight gain during pregnancy was 8.9 kg. Preeclampsia appeared in 2.7 %, gestational diabetes (GD) in 5.7 % and cesarean delivery was performed at 42.5 %. Small for gestational age (SGA) neonates were diagnosed in 15.8 % and large for gestational age (LGA) neonates in 3.7 %. Limited data exist on the subject and further prospective studies are needed to prove the exact evidence of relation between LSG and pregnancy outcomes. Initial studies show that patients with LSG present lower rates of GD and LGA neonates, higher rates of SGA neonates and similar rates of hypertensive disorders and prematurity when compared to non operated controls. Time interval between LSG and conception is not proven to have a statistically significant impact on maternal or neonatal outcomes.