1. Spontaneous Hepatic rupture due to Preeclampsia Shilpa Mahadasu *, G Kanuga University Hospital North Durham, Durham, UK Introduction:  Severe Preeclampsia is associated with life threatening complications which are cerebral and hepatic in origin. 1  Preeclampsia associated hepatic haemorrhage can be difficult to diagnose due to the overlap of symptoms and signs of severe preeclampsia and hepatic rupture, the former masking the important clinical signs of the latter. 1 in 45,000 - 1 in 225,000 2 and it is common in the right lobe of liver.  The incidence is 1 in 45,000 - 1 in 225,000 2 and it is common in the right lobe of liver.  USS and CT scan are useful diagnostic modalities, however diagnosis is “elusive” and 33% of cases are diagnosed by Laparotomy only.  Both maternal and perinatal survival have improved with advances in intensive care & interventional radiology. Case presentation: Management options: Clinical suspicion - Ultrasound (Henry et al,1982)- CT -Tc 99 scan -Hepatic Angiography- Laparoscopy  Diagnosis: Clinical suspicion - Ultrasound (Henry et al,1982)- CT -Tc 99 scan -Hepatic Angiography- Laparoscopy Laparotomy - 33% onservative management -Temporary packing and drain-Mesh hepatorraphy- Haemostatic agents -Hepatic artery ligation-Hepatic embolisation  Treatment : Conservative management -Temporary packing and drain-Mesh hepatorraphy- Haemostatic agents -Hepatic artery ligation-Hepatic embolisation Hepatic lobectomy -Liver transplantation Hepatic lobectomy -Liver transplantation References 1) Saving Mothers Lives:Reviewing maternal deaths to make motherhood safer;2006-2008 :Vol. 118 2) Brian K, Rinehart-Preeclampsia associated hepatic haemorrhage and rupture;Mode of management related to maternal and perinatal outcome. A 35 year old Primigravida,31 weeks gestation was admitted with diarrhoea, vomiting and abdominal pain. Observations included Oxygen saturation( 98%), Pulse rate(67/min), Blood Pressure(190/110), Cold extremities, Urine dip stick(protein 3+). Pre-eclampsia protocol was commenced. After one hour, Per-operatively After extubation, a haemoperitoneum of 1000 ml. was noted. On further exploration, a Length of hospital stay was A 35 year old Primigravida,31 weeks gestation was admitted with diarrhoea, vomiting and abdominal pain. Observations included Oxygen saturation( 98%), Pulse rate(67/min), Blood Pressure(190/110), Cold extremities, Urine dip stick(protein 3+). Pre-eclampsia protocol was commenced. After one hour, Persistent fetal bradycardia was noted on the CTG and that point of time,the Platelet count was 73 and ALT was 1944. Emergency LSCS was performed. Per-operatively fresh blood(200ml) was noted in the peritoneal cavity. Baby girl delivered – some resuscitation required. As there was free blood, general surgical opinion was sought and after further examination, the LSCS wound was closed with two drains. After extubation, abdominal drains filled rapidly. On midline Laparotomy by general surgeons, haemoperitoneum of 1000 ml. was noted. On further exploration, a 5 cm laceration on the posterior aspect of the right lobe of the liver was noted which was packed with Haemostatic agent and Laparostomy closure was performed with packs in situ. Planned re-exploration and removal of packs was performed after 24 hrs and the patient was stable. Patient developed transient renal failure during post-operative period but recovered fully. Length of hospital stay was three weeks-she was discharged home with a healthy baby. Hepatic ischaemia ----haemorrhage Neovascularisation Fragile vessels---rupture Subcapsular haematoma Hepatic capsule ruptur e Epigastric pain69.5% Hypertension65% Shock56% Shoulder pain20.5% Fibri n deposition and hypovolaemia