Advertisement

Archives of Gynecology and Obstetrics

, Volume 298, Issue 2, pp 235–242 | Cite as

Diagnosis and management of primary hepatic pregnancy: literature review of 31 cases

  • Jicai Wang
  • Zhilei Su
  • Shounan Lu
  • Wen Fu
  • Zhifa Liu
  • Xingming Jiang
  • Sheng Tai
Review

Abstract

Purpose

To summarize the appropriate diagnostic methods and therapeutic options for primary hepatic pregnancy (PHP).

Methods

Literature searches were performed in Pubmed, Web of Science, Cochrane Library and Embase databases (1956–2017), using the following search terms: primary hepatic pregnancy, hepatic pregnancy, liver pregnancy, hepatic ectopic pregnancy and intrahepatic pregnancy. Further literature was confirmed through cross-referencing.

Results

Thirty-one cases were reviewed and collected. The site mostly described in literatures is the right lobe of liver (93.5%). Main symptoms of PHP included abdominal pain (77.4%), amenorrhea (45.2%), acuteperitonism (32.3%), shock (25.8%) and vomit (16.1%). Majority of patients (83.9%) were treated by laparotomy. Less-invasive approaches (16.1%) such as laparoscopy or combination of postoperative injection of methotrexate were used less frequently. The outcome was acceptable at the end of the follow-up period in ten cases (1–72 months) and the recovery rate was 96.7%. One patient died and other complications were noted in three patients during the postoperative period.

Conclusions

The clinical diagnosis of PHP can be settled up by comprehensive analysis of serum HCG levels, ultrasound and imaging. The analysis should be assessed carefully before therapeutic procedure. Invasive methods should be preferential. Less-invasive approaches can be selected when the patients have stable hemodynamics and non-acute abdomen.

Keywords

Primary hepatic pregnancy Hepatic pregnancy Liver pregnancy Hepatic ectopic pregnancy Intrahepatic pregnancy 

Notes

Author contributions

JW: data collection, data analysis, manuscript writing. WF and ZL: data collection. ZS and SL: data analysis. XJ and ST: manuscript writing, supervision.

Funding

This study was funded by National Natural Science Foundation of China (Grant no. 81602088), Health and Family Planning Commission Research Project of Heilongjiang Province (Grant No. 2016-049), Heilongjiang Postdoctoral Science Foundation (Grant No. LBH-Z16096), Innovative Science Foundation of Harbin Medical University (Grant No. 2016LCZX09), China Postdoctoral Science Foundation (Grant No. 2017M621305) and Wu Jieping Medical Foundation (Grant No. 320.6750.1245).

Compliance with ethical standards

Conflict of interest

We declare that we have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Zhang Y, Kang D, Zhang B, Yang L, Fan Z (2016) Ectopic pregnancy causing splenic rupture. Am J Emerg Med 34(6):1184(e1–2).  https://doi.org/10.1016/j.ajem.2015.11.011 CrossRefGoogle Scholar
  2. 2.
    Bashir RM, Montgomery EA, Gupta PK, Nauta RM, Crockett SA, Collea JV, Al-Kawas FH (1995) Massive gastrointestinal hemorrhage during pregnancy caused by ectopic decidua of the terminalileum and colon. Am J Gastroenterol 90(8):1325–1327PubMedGoogle Scholar
  3. 3.
    Chen L, Qiu L, Diao X, Yue Q, Gong Q (2015) CT findings of omental pregnancy: a case report. Jpn J Radiol 33(8):499–502.  https://doi.org/10.1007/s11604-015-0449-7 CrossRefPubMedGoogle Scholar
  4. 4.
    Worley KC, Hnat MD, Cunningham FG (2008) Advanced extrauterine pregnancy: diagnostic and therapeutic challenges. Am J Obstet Gynecol 198(3):297(e1–7).  https://doi.org/10.1016/j.ajog.2007.09.044 CrossRefGoogle Scholar
  5. 5.
    Kirby NG (1969) Primary hepatic pregnancy. Br Med J 1(5639):296CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Shukla VK, Pandey S, Pandey LK, Roy SK, Vaidya MP (1985) Primary hepatic pregnancy. Postgrad Med J 61(719):831–832CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Yadav R, Raghunandan C, Agarwal S, Dhingra S, Chowdhary S (2012) Primary hepatic pregnancy. J Emerg Trauma Shock 5(4):367–369.  https://doi.org/10.4103/0974-2700.102417 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Chui AK, Lo KW, Choi PC, Sung MC, Lau JW (2001) Primary hepatic pregnancy. ANZ J Surg 71(4):260–261CrossRefPubMedGoogle Scholar
  9. 9.
    Veress B, Wallmander T (1987) Primary hepatic pregnancy. Acta Obstet Gynecol Scand 66:563–564CrossRefPubMedGoogle Scholar
  10. 10.
    Luwuliza-Kirunda JM (1978) Rrimary hepatic pregnancy case report. Acta Obstet Gynecol Scand 66(6):563–564Google Scholar
  11. 11.
    Tu J, Wang E, Shen J (2016) Primary hepatic ectopic pregnancy: a case report. J Reprod Med 61(3–4):175–178PubMedGoogle Scholar
  12. 12.
    Barbosa Júnior Ade A, de Freitas LA, Mota MA (1991) Primary pregnancy in the liver. A case report. Pathol Res Pract 187(2–3):329–331 (discussion 332–3) CrossRefPubMedGoogle Scholar
  13. 13.
    Mitchell RW, Teare AJ (1984) Primary hepatic pregnancy. A case report and review. S Afr Med J 65(6):220PubMedGoogle Scholar
  14. 14.
    Nichols C, Koong D, Faulkner K, Thompson G (1995) A hepatic ectopic pregnancy treated with direct methotrexate injection. Aust N Z J Obstet Gynaecol 35(2):221–223CrossRefPubMedGoogle Scholar
  15. 15.
    Jáné Z, Farkasdi J, Jáger L, Kneffel P, Koppány C, Márkus B, Puskás T (2008) A rare localisation of ectopic pregnancy—a case of hepatic pregnancy. Magy Seb 61(5):270–272.  https://doi.org/10.1556/MaSeb.61.2008.5.3 CrossRefPubMedGoogle Scholar
  16. 16.
    Wang T, Chen P, Bian D (2017) Primary hepatic pregnancy. Clin Res Hepatol Gastroenterol 41(3):241–242.  https://doi.org/10.1016/j.clinre.2016.10.009 CrossRefPubMedGoogle Scholar
  17. 17.
    Hu S, Song Q, Chen K, Chen Y (2014) Contrast-enhanced multiphasic CT and MRI of primary hepatic pregnancy: a case report and literature review. Abdom Imaging 39(4):731–735.  https://doi.org/10.1007/s00261-014-0101-5 CrossRefPubMedGoogle Scholar
  18. 18.
    Shippey SH, Bhoola SM, Royek AB, Long ME (2007) Diagnosis and management of hepatic ectopic pregnancy. Obstet Gynecol 109(2 Pt2):544–546.  https://doi.org/10.1097/01.AOG.0000247293.32523.c3 CrossRefPubMedGoogle Scholar
  19. 19.
    Kuai XP, Wang SY, Qiu JM (2013) Ectopic pregnancy implanted in the liver under the diaphragm. Taiwan J Obstet Gynecol 52(4):586–587.  https://doi.org/10.1016/j.tjog.2013.10.024 CrossRefPubMedGoogle Scholar
  20. 20.
    Hietala SO, Andersson M, Emdin SO (1983) Ectopic pregnancy in the liver. Report of a case and angiographic findings. Acta Chir Scand 149(6):633–635PubMedGoogle Scholar
  21. 21.
    Krause DW (1979) Hepatic tumor or hepatic pregnancy? AJR Am J Roentgenol 133(2):355–356.  https://doi.org/10.2214/ajr.133.2.355 CrossRefPubMedGoogle Scholar
  22. 22.
    Hao J, Cheng Z, Hu N, Xiao L, Wang Y (2016) Imaging of hepatic ectopic pregnancy by 18F-FDG PET/CT. Clin Nucl Med 41(9):697–698.  https://doi.org/10.1097/RLU.0000000000001307 CrossRefPubMedGoogle Scholar
  23. 23.
    Delabrousse E, Site O, Le Mouel A, Riethmuller D, Kastler B (1999) Intrahepatic pregnancy: sonography and CT findings. AJR Am J Roentgenol 173(5):1377–1378.  https://doi.org/10.2214/ajr.173.5.10541123 CrossRefPubMedGoogle Scholar
  24. 24.
    Harris GJ, Al-Jurf AS, Yuh WT, Abu-Yousef MM (1989) Intrahepatic pregnancy. A unique opportunity for evaluation with sonography, computed tomography, and magnetic resonance imaging. JAMA 261(6):902–904CrossRefPubMedGoogle Scholar
  25. 25.
    Chin PS, Wee HY, Chern BS (2010) Laparoscopic management of primary hepatic pregnancy. Aust N Z J Obstet Gynaecol 50(1):95–98.  https://doi.org/10.1111/j.1479-828X.2009.01113.x CrossRefPubMedGoogle Scholar
  26. 26.
    Murley AH (1956) Liver pregnancy. Lancet 270(6930):994–995CrossRefPubMedGoogle Scholar
  27. 27.
    Ma J, Zhou C, Duan Z, Jiang Y (2013) Successful management of primary hepatic pregnancy with selective hepatic artery embolization and intra-arterial methotrexate infusion. Int J Gynaecol Obstet 122(1):78–79.  https://doi.org/10.1016/j.ijgo.2013.02.019 CrossRefPubMedGoogle Scholar
  28. 28.
    Sibetcheu Tchatou A, Tchounzou R, Mbuagbaw L, Mboudou ET (2017) Successful medical treatment of a hepatic pregnancy: a case report. J Med Case Rep 11(1):70.  https://doi.org/10.1186/s13256-017-1227-1 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Ramphal SR, Moodley J, Rajaruthnam D (2010) Hepatic pregnancy managed conservatively. Trop Dr 40(2):121–122.  https://doi.org/10.1258/td.2009.090218 CrossRefGoogle Scholar
  30. 30.
    Moores KL, Keriakos RH, Anumba DO, Connor ME, Lashen H (2010) Management challenges of a live 12-week sub-hepatic intra-abdominal pregnancy. BJOG 117(3):365–368.  https://doi.org/10.1111/j.1471-0528.2009.02450.x CrossRefPubMedGoogle Scholar
  31. 31.
    Brouard KJ, Howard BR, Dyer RA (2015) Hepatic pregnancy suspected at term and successful delivery of a live neonate with placental attachment to the right lobe of the liver. Obstet Gynecol 126(1):207–210.  https://doi.org/10.1097/AOG.0000000000000703 CrossRefPubMedGoogle Scholar
  32. 32.
    Qiao JC, Chang ZG, Wei JM, Liu YN, Cui HY, Zhang Y (2013) Hepatic ectopic pregnancy treated successfully by hepatectomy. Chin Med J (Engl) 126(24):4806–4807Google Scholar
  33. 33.
    Cai YY, Xiao EH, Shang QL, Xiao LZ (2017) Ectopic pregnancy in the liver incidentally diagnosed by imaging: a case report. Exp Ther Med 14(1):373–376.  https://doi.org/10.3892/etm.2017.4478 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Wang C, Cheng L, Zhang Z, Yuan Z (2012) Imaging diagnosis of hepatic ectopic pregnancy: a report of one case. Intractable Rare Dis Res 1(1):40–44.  https://doi.org/10.5582/irdr.2012.v1.1.40 PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Børlum KG, Blom R (1988) Primary hepatic pregnancy. Int J Gynaecol Obstet 27(3):427–429CrossRefPubMedGoogle Scholar
  36. 36.
    Parker VL, Srinivas M (2016) Non-tubal ectopic pregnancy. Arch Gynecol Obstet 294(1):19–27.  https://doi.org/10.1007/s00404-016-4069-y CrossRefPubMedGoogle Scholar
  37. 37.
    Bakhshi GD, Borisa AD, Bhandarwar AH, Tayade MB, Yadav RB, Jadhav YR (2012) Primary hepatic choriocarcinoma: a rare cause of spontaneous hemoperitoneum in an adult. Clin Pract 2(3):e73.  https://doi.org/10.4081/cp.2012.e73 PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Rana P, Kazmi I, Singh R, Afzal M, Al-Abbasi FA, Aseeri A, Singh R, Khan R, Anwar F (2013) Ectopic pregnancy: a review. Arch Gynecol Obstet 288(4):747–757.  https://doi.org/10.1007/s00404-013-2929-2 CrossRefPubMedGoogle Scholar
  39. 39.
    Mittal S, Aird I, Haugk B (2012) Gestational choriocarcinoma in liver mimicking ruptured ectopic pregnancy. J Obstet Gynaecol 32(5):499.  https://doi.org/10.3109/01443615.2012.675369 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Hepatopancreatobiliary SurgeryThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina

Personalised recommendations