Undiagnosed Subcapsular Liver Hematoma Rupture in HELLP Syndrome Unveiled during Emergency Cesarean Delivery: Case Report

Background: HELLP syndrome (Hemolysis, Elevated Liver Enzymes, and Low Platelets) is a severe obstetric complication that affects approximately 1% of pregnancies but occurs in 10–20% of cases with preeclampsia. One of its most serious complications is spontaneous hepatic hematoma, which can lead to life-threatening liver rupture in rare cases. Early diagnosis and timely intervention are crucial for improving maternal and fetal outcomes. Case Presentation: We report the case of a 35-year-old gravida 3 para 2 woman at 35 weeks of gestation who presented with persistent upper abdominal pain. She was diagnosed with HELLP syndrome, and an emergency cesarean section was performed due to acute fetal distress. During surgery, the patient developed hemodynamic instability, prompting an exploratory laparotomy, which revealed a ruptured hepatic subcapsular hematoma with active bleeding. Surgical management involved peri-hepatic packing and massive transfusion. Postoperatively, the patient was closely monitored in the intensive care unit, where she showed progressive clinical and biochemical improvement. She was successfully discharged on the twelfth postoperative day and exhibited a favorable recovery at follow-up. Conclusions: Although rare, hepatic hematoma and capsular rupture are life-threatening complications of HELLP syndrome. Given the nonspecific clinical presentation, a high index of suspicion is essential for early diagnosis. Imaging studies should be promptly performed in suspected cases, and when rupture occurs, immediate surgical intervention is necessary to optimize outcomes.