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.