Multidisciplinary management of the pregnant patient in haemorrhagic shock secondary to an undiagnosed ruptured liver adenoma

Sanford, Brittany; Hoeppner, Catherine; Ju, Tammy; Theisen, Brian; BuAbbud, Anna; Estroff, Jordan

doi:10.1136/bcr-2019-231995

Cited by 4 publications

(3 citation statements)

References 9 publications

(14 reference statements)

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“…Fifteen cases of HCA-associated hemorrhage were included, none occurred in the first trimester and all HCA measuring 6.5 cm. 33,34,36,43,44,46,49,52 Eight HCA bled during gestation, seven in the third trimester. The remaining seven bleeding cases occurred during labor (n = 2) or postpartum (n = 5).…”

Section: Discussionmentioning

confidence: 99%

“…11, OCP status was reported in most studies (79%). 26,28,30,[42][43][44][45]52 Four cohort studies reported insufficient information on patient characteristics, HCA size, and HCA behavior for reporting and pooling of individual patients. 3,[54][55][56] One case report and one cohort study reported on hepatocyte nuclear factor 1a maturity onset diabetes of the young (HNF1A-MODY)-associated HCA.…”

Section: Data Extraction and Critical Appraisalmentioning

confidence: 99%

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Behavior and complications of hepatocellular adenoma during pregnancy and puerperium: a retrospective study and systematic review

Haring

Spijkerboer

Cuperus

et al. 2021

HPB

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Background: Hepatocellular adenomas (HCA) are benign liver tumors at risk of hemorrhage. The influence of pregnancy on HCA growth and potential bleeding remains unclear. This study investigates HCA-associated behavior and bleeding complications during or shortly after pregnancy. Methods: (I) Single center retrospective cohort study of HCA during and after pregnancy (II) Systematic literature review.Results: The retrospective study included 11 patients, of which 4 with HCA 5 cm. In only two patients HCA showed growth during pregnancy. In this local cohort, no HCA-related hemorrhages occurred during median follow-up of 34 months (interquartile range 19-58 months). The systematic review yielded 33 studies, totaling 90 patients with 99 pregnancies. Of 73 pregnancies without prior HCA-related intervention, 39 HCA remained stable (53.4%), 11 regressed (15.1%), and 23 (31.5%) progressed.Fifteen HCA-related hemorrhages occurred in HCA measuring 6.5-17.0 cm. Eight patients experienced bleeding during pregnancy, two during labor and five postpartum.Discussion: Although hemorrhage of HCA during or shortly after pregnancy is rare and only reported in HCA 6.5 cm, it can be fatal. Pregnancy in women with HCA, regardless of size, warrant a close surveillance strategy. Observational studies on behavior and management of HCA 5 cm during and immediately after pregnancy are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Data Extraction and Critical Appraisalmentioning

confidence: 99%

Behavior and complications of hepatocellular adenoma during pregnancy and puerperium: a retrospective study and systematic review

Haring

Spijkerboer

Cuperus

et al. 2021

HPB

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“…However, it has been documented. In a recent case report, a 30-year-old primigravid was managed with temporary packing and definitive control of hemorrhage via angioembolization of a bleeding HCA [ 7 ]. This case report highlighted the importance of a multidisciplinary approach in managing this rare, but life-threatening condition.…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Simulation Improves Resident Confidence for Pregnant Patients Requiring Surgical Intervention

Harrington¹,

Duncan²,

DAngelo³

et al. 2022

Cureus

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Introduction: Hepatocellular adenomas are a rare but serious cause of bleeding, which is further complicated by pregnancy. Interprofessional cooperation is a key component of residency education, thus simulations designed to integrate multiple programs are mutually beneficial. This simulation details surgical and obstetric management of a pregnant patient in hemorrhagic shock from a bleeding hepatocellular adenoma. Objectives for the study were to evaluate learners’ confidence to 1) prioritize the care of a pregnant patient with hemoperitoneum and hemorrhagic shock, 2) demonstrate interdisciplinary collaboration with other specialties, 3) apply massive transfusion protocol (MTP) in the appropriate clinical setting, and 4) analyze critical decisions for evaluating pregnant females with severe abdominal pain. Methods: Obstetric, general surgery, and anesthesia residents, along with labor and delivery nurses participated in a simulated clinical scenario that focused on the management of a pregnant patient in hemorrhagic shock. The learners evaluated the educational session using a standard Return on Investment in Learning survey immediately following the session. Results: A total of 23 residents and medical students gave feedback on the experience. The main learning objectives were met with increased confidence in the four learning objectives by 77.3-95.4% of responders. Overall, greater than 90% of participants felt the simulation was relevant to their training and realistic, with 100% responding that the course provided new, or clarified existing information for them. Conclusion: A multidisciplinary simulation-based educational intervention was successful in improving learner confidence in managing a complicated surgical emergency in a pregnant patient with inter-residency cooperation.

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Hepatic adenoma: evolution of a more individualized treatment approach

Aziz,

Underwood,

Gosse

et al. 2024

Journal of Gastrointestinal Surgery

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Multidisciplinary management of the pregnant patient in haemorrhagic shock secondary to an undiagnosed ruptured liver adenoma

Cited by 4 publications

References 9 publications

Behavior and complications of hepatocellular adenoma during pregnancy and puerperium: a retrospective study and systematic review

Behavior and complications of hepatocellular adenoma during pregnancy and puerperium: a retrospective study and systematic review

Multidisciplinary Simulation Improves Resident Confidence for Pregnant Patients Requiring Surgical Intervention

Hepatic adenoma: evolution of a more individualized treatment approach

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