Subcapsular Hepatic Hematoma in Preeclampsia:A 25-Year Series of 23 Cases

Background: Subcapsular hepatic hematoma (SHIH) is a rare but lifethreatening complication of severe preeclampsia and HELLP syndrome. This study aims to analyze the epidemiological, clinical, and therapeutic characteristics of SHIH and to identify prognostic factors associated with maternal mortality over a 25-year period in a single tertiary center. Methods: We conducted a retrospective cohort study of all patients diagnosed with SHIH in the context of preeclampsia at our institution between January 2000 and December 2024. We analyzed maternal characteristics, clinical presentation, biological and radiological findings, management strategies, and maternal-fetal outcomes. A multivariate logistic regression was performed to identify independent risk factors for mortality. Results: Twenty-three patients were included. The overall incidence was 1 in 10,435 deliveries. Maternal mortality was 34.8% (8/23). The main risk factors for mortality identified in multivariate analysis were hemorrhagic shock (OR = 36.0, p < 0.001) and capsular rupture (OR = 10.5, p = 0.02). Conservative management was successful in 85.7% of cases, whereas surgical management was associated with a 66.7% mortality rate. A significant decrease in mortality was observed over time, from 50% in the first decade to 14.3% in the last. Conclusion: SHIH remains a severe complication of preeclampsia with high mortality. Hemorrhagic shock and capsular rupture are the main prognostic factors. The trend towards conservative management in hemodynamically stable patients with intact hematomas has significantly improved maternal prognosis.