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We conducted a systematic search of online databases using search terms, (\u2018liver\u2019 AND \u2018pregnancy\u2019) AND (\u2018haematoma\u2019 OR \u2018rupture\u2019) in order to present a narrative review of the literature and a systematic management framework. Our series is the first Australian report of spontaneous subcapsular haematoma in pregnancy with one fetal death in utero but no maternal deaths. Our systematic search of online databases revealed 45 similar reports in the last ten\u00a0years. Individual patient data were available for 73 cases. The overwhelming majority of these reports were single cases or small case series. We estimate the mean maternal mortality rate to be 15% but fetal mortality was substantially greater than 15% (although data for neonatal outcomes was incomplete). There was one case report of liver transplantation with excellent maternal and fetal outcome. In the last five years, modern diagnostic techniques and therapeutic options have significantly reduced maternal and fetal mortality. Hepatic artery embolisation is a minimally invasive approach under guidance of imaging and is likely to achieve the best maternal and fetal outcomes. Based on our literature review, we have provided a systematic management framework for spontaneous liver haematoma in pregnancy.<\/jats:p>","DOI":"10.1111\/ajo.13318","type":"journal-article","created":{"date-parts":[[2021,2,14]],"date-time":"2021-02-14T09:40:07Z","timestamp":1613295607000},"page":"188-194","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Managing a rare complication of HELLP syndrome in Australia: Spontaneous liver haematoma in pregnancy"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5065-7279","authenticated-orcid":false,"given":"Akhil","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Obstetric Medicine Flinders Medical Centre (FMC) Adelaide South Australia Australia"},{"name":"Macarthur Clinical School (School of Medicine \u2013 Campbelltown) Western Sydney University Sydney New South Wales 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