Spontaneous peripartum liver haemorrhage presenting as foetal distress

We present the case of a 32-year-old woman who presented at 37 weeks’ gestation with foetal bradycardia. At caesarean delivery, an intra-abdominal haemorrhage was noted before the uterine incision was made. A subsequent exploratory laparotomy revealed the source of the bleeding to be an extensive ruptured haematoma involving both lobes of the liver. Radiologic investigations revealed the presence of multiple cavernous haemangiomata in the liver. The perioperative management of this patient is described, with a brief review of the literature.