Imaging negative subcapsular liver hematoma in parturients with HELLP syndrome: a report of two cases.

Introduction and importance: We report two cases of parturients with HELLP syndrome who were diagnosed with subcapsular liver hemorrhage (SLH) during an emergency cesarean section. Case presentation: In case 1, a 30-year-old woman who was pregnant at 34+ weeks was admitted because of fetal heart rate deceleration. On the third day of hospitalization, the patient experienced upper abdominal pain. Considering the diagnosis of HELLP syndrome, an emergency cesarean section was performed under general anesthesia. Multiple SLH sites were discovered during laparoscopic exploration, but no intervention was performed. After surgery, the patient's platelet count, transaminase levels, and other indicators gradually returned to nearly normal levels. In case 2, a 30-year-old woman was admitted to the hospital at 34 + 1 weeks of pregnancy with elevated blood pressure for 1 week and thoracodorsal pain for 1 day. An emergency cesarean section was performed under general anesthesia. We performed laparoscopic exploration and identified SLH in the right liver near the diaphragm without obvious active bleeding. No further interventions were performed. The patient recovered well after surgery and was discharged on the fifth day after surgery. Clinical discussion: Our report suggests that thoracodorsal pain may be an early symptom of SLH, and the incidence of SLH may be underestimated. Even with negative imaging results, SLH cannot be ruled out, and clinicians need to pay sufficient attention to actively prevent and treat it. Conclusions: Even if the ultrasound examination is negative, SLH cannot be completely excluded, and conservative treatment is advisable under specific circumstances. Keywords: preeclampsia, HELLP syndrome, pregnancy, cesarean section, liver.