Characteristics and Outcomes Associated with Hepatic Infarction in Pregnancy [13E]

INTRODUCTION: Hepatic infarction is a rare pregnancy complication. We sought to review the literature to characterize risk factors, presentation, and outcomes associated with hepatic infarction in pregnancy. METHODS: We performed a systematic literature review using PUBMED and MEDLINE 1966-2017 with relevant search terms to identify reported cases of hepatic infarction in pregnancy. Maternal demographics, comorbidities, risk factors, presenting signs and symptoms, diagnostic tests, management, and outcomes were abstracted. RESULTS: We identified 45 cases (33 articles) of hepatic infarction in pregnancy. Average maternal age was 29 ± 5 years. Majority of cases occurred in nulliparous women (56%). Mean gestational age at presentation was 28 ± 8 weeks. The most common risk factors were preeclampsia/HELLP syndrome (67%) and antiphospholipid syndrome (53%). The most common presenting symptoms were abdominal pain (89%), elevated blood pressure (77%), nausea/vomiting (50%), and fever (34%). Abdominal pain was typically right upper quadrant (52%) or epigastric (39%). An upper abdominal ultrasound was performed in 50% of cases; however, 91% did not demonstrate hepatic infarction. Diagnosis was typically made with computerized tomography. Therapeutic anticoagulation and corticosteroids were the most common therapy used. Preterm birth occurred in 82% of cases and fetal demise was common (45%). CONCLUSION: Hepatic infarction is a rare complication of pregnancy that is associated with preeclampsia and antiphospholipid antibody syndrome and has a high rate of fetal demise. Additional imaging is required if initial ultrasound is normal and there is a concern for hepatic infarction.