Spontaneous liver rupture associated with HELLP syndrome

Background: Spontaneous hepatic rupture is a rare life-threatening event seen among patients with preeclampsia and HELLP syndrome bringing devastating outcomes to both the mother and the baby.Case presentation: We report a case of a 45-year-old sub fertile primigravida following an IVF treatment with donor embryo resulting in DCDA twin pregnancy.She was diagnosed with pregnancy induced hypertension at 20 weeks of period of gestation (POG) with DCDA twin pregnancy admitted at our hospital at 32 + 4 weeks of POG with headache, visual disturbances, vomiting and abdominal pain with severe pregnancy induced hypertension. Category I emergency cesarean section was performed due to eclampsia, suspected placental abruption with DCDA twins with single fetal demise and acute kidney injury. During caesarean section, right lobe of the liver rupture was diagnosed. Even with intense multidisciplinary management the life of this mother could not be saved leaving behind her newborn baby with the father.Conclusion: Due to the rarity of the entity, the unpredictable nature and the multisystemic involvement, many health care providers as well as pregnant women may not be aware of the fatal consequences of this complication.