Hypertensive disorders: hepatic haematoma in HELLP: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Hypertensive disorders: hepatic haematoma in HELLP

Sample item

A woman with HELLP syndrome, delivered yesterday, develops sudden severe right upper abdominal pain radiating to the right shoulder, with hypotension and a distended abdomen. What is the most likely complication?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Rupture of a subcapsular liver haematoma

In HELLP, periportal haemorrhage can form a subcapsular liver haematoma, which may rupture and cause shock with pain referred to the shoulder. Management is resuscitation with blood products and laparotomy with packing, or embolisation if stable.

Option by option

  • A. Placental abruption

    Placental abruption cannot occur after the placenta has been delivered.

  • B. Acute pulmonary embolism

    Pulmonary embolism presents with dyspnoea and pleuritic pain, not abdominal distension.

  • C. Acute cholecystitis

    Cholecystitis does not cause haemorrhagic shock and abdominal distension.

  • D. Rupture of a subcapsular liver haematoma (correct)

    Correct. Hepatic haematoma rupture explains pain, shoulder-tip radiation and shock.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Rupture of a subcapsular liver haematoma. In HELLP, periportal haemorrhage can form a subcapsular liver haematoma, which may rupture and cause shock with pain referred to the shoulder.

Why is "Placental abruption" not the answer?

Placental abruption cannot occur after the placenta has been delivered.

Why is "Acute pulmonary embolism" not the answer?

Pulmonary embolism presents with dyspnoea and pleuritic pain, not abdominal distension.

Why is "Acute cholecystitis" not the answer?

Cholecystitis does not cause haemorrhagic shock and abdominal distension.

What concept does this question test?

It tests Hypertensive disorders: hepatic haematoma in HELLP in OBG. Management is resuscitation with blood products and laparotomy with packing, or embolisation if stable.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hypertensive disorders: hepatic haematoma in HELLP?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.