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Less commonly, hepatic rupture complicates growth of hepatic adenomata or other masses during pregnancy.3 Hepatic rupture most commonly involves the right lobe.4 It is believed to be a continuum of preeclampsia, in which areas of coalescing hemorrhage result in thinning plump pussy of the capsule and intraperitoneal hemorrhage.4 Case reports have documented plump pussy numerous pseudoaneurysms in the area of hemorrhage, raising the possibility of a vasculopathy contributing to this rare disorder.35 Patients with hepatic rupture typically present in shock, with preceding right upper quadrant pain, hypertension, elevated transaminase levels (greater than 1,000 IU per L) and coagulopathy.4 Therapy for hepatic plump pussy rupture has included transfusion of blood products and intravenous fluids, surgical evacuation and arterial embolization.4 These therapies have met with only moderate success; a 59 to 70 percent maternal mortality rate and a 75 percent perinatal mortality rate have been noted in hepatic rupture.4
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