Hepatic Pregnancy: A Rare Form of Ectopic Pregnancy

A few days ago, a colleague shared a video of a real-time pregnancy developing in the liver, and I was in complete disbelief. This is an extremely rare form of ectopic pregnancy, with an estimated incidence of 1 in 8,000 births. While abdominal pregnancies are already uncommon, hepatic pregnancies—where the embryo implants in the liver—are even more exceptional.

Recent Case in Namibia

A recently reported case in Namibia has reignited discussions in the medical community about this rare phenomenon. The video evidence highlights the complexity of hepatic pregnancies and the significant challenges in their management.

Understanding Hepatic Pregnancy

Hepatic pregnancy falls under the broader category of abdominal pregnancies, which account for approximately 1.4% of all ectopic pregnancies. Most abdominal pregnancies implant in the pelvis, but in extremely rare cases, implantation occurs in the upper abdomen, particularly in the liver.

Case Study from the Literature

A documented case published in the Journal of Emergency, Trauma, and Shock provides insights into the clinical presentation and challenges in managing hepatic pregnancies:

Patient Profile: A 25-year-old woman, G2P1L1, presented with an 18-week pregnancy, experiencing right upper abdominal pain and vomiting for a week.

Diagnosis: Ultrasound revealed a live fetus attached to the underside of the liver, accompanied by moderate ascites.

Surgical Intervention: Laparotomy confirmed a hepatic pregnancy with significant internal bleeding (500cc of hemoperitoneum). The fetus was removed, but due to uncontrolled bleeding from the placenta, it was left in situ.

Complications & Outcome: Despite attempts at hemostasis, including hepatic artery embolization and multiple surgeries, the patient developed disseminated intravascular coagulation (DIC) and did not survive.

Lessons and Potential Advancements

The tragic outcome of this case underscores the challenges in treating hepatic pregnancies. However, advancements in interventional radiology and surgical techniques could improve future management. Key takeaways include:

Early Diagnosis with Advanced Imaging: High-resolution ultrasound, MRI, and contrast-enhanced CT scans can aid in early detection, potentially improving outcomes.

Preoperative Embolization: The authors suggest that embolization of the hepatic artery before surgery could reduce bleeding risks.

Liver Resection Considerations: In select cases, partial hepatic resection might be necessary to completely remove the placenta and minimize hemorrhage.

Multidisciplinary Approach: A team involving obstetricians, radiologists, hepatobiliary surgeons, and anesthesiologists is crucial for optimizing patient survival.

Conclusion

Hepatic pregnancies remain a rare and life-threatening obstetric emergency. While medical literature has documented cases, the recent report from Namibia brings renewed attention to this condition. Advances in diagnostic imaging, interventional radiology, and surgical planning could help improve patient outcomes in the future. More research and awareness are needed to refine treatment protocols and reduce mortality in these highly complex cases.