Spontaneous 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. Literature 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. Three 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. The 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 V

中文翻译：

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妊娠期高血压疾病并发肝破裂或血肿：391例报告病例的系统评价


妊娠期自发性肝破裂常常未被识别、高度致命且尚未完全了解。目的是总结和定义妊娠/产褥期自发性肝破裂（SHRP）并发高血压的病因、危险因素、临床表现、适当的诊断方法和治疗选择。所有全文文章的文献检索包括 PubMed (1946-2021)、PubMed Central (1900-2021) 和 Google Scholar。检索了妊娠期或产褥期高血压疾病（先兆子痫、子痫、HELLP 综合征）并发症导致自发性肝破裂或肝血肿的病例报告。收集病例没有语言限制。通过审查检索到的研究参考文献，发现了更多病例。应用了数据提取和质量评估的 PRISMA 指南。共收集病例三百九十一个。产妇年龄中位数为 31 岁（范围 17-48）； 36.6%未生育。大多数（83.4%）发生在妊娠晚期。孕产妇和胎儿死亡率分别为22.1%和37.2%。孕产妇和胎儿死亡率明显较高：1) 1990 年之前，2) 孕产妇血流动力学不稳定，3) 子痫。 SHRP 最重要的危险因素是先兆子痫和 HELLP 综合征。大多数女性右叶受到影响（70.9%），其次是双叶（22.1%）和左叶（6.9%）。最常见的外科手术是肝脏填塞。肝移植的实施率为 4.7%，存活率为 100%。肝栓塞的孕产妇死亡率为 3.0%。较高胎龄可提高胎儿存活率。 SHRP 的诊断和治疗常常被延误，导致孕产妇和胎儿死亡率较高。 对于患有先兆子痫/子痫或 HELLP 综合征且右上腹疼痛的血流动力学不稳定患者，应排除 SHRP。肝栓塞和肝移植有助于孕产妇生存。 1990年之前，孕产妇和胎儿死亡率显着升高。血流动力学不稳定、先兆子痫和子痫对孕产妇生存有显着的负面影响。Ⅴ级