Protecting the fetus during hepatic surgery in pregnancy: the role of cavo-caval bypass

Abstract

The discovery of a liver mass during pregnancy requires careful etiological assessment.A 29-year-old woman was diagnosed with a 17-cm inflammatory hepatocellular adenoma at 24-weeks of gestation. Given the high risk of spontaneous rupture and bleeding,a multidisciplinary team opted for a right hepatectomy at 26-weeks. To maintain stable maternal hemodynamics and avoid fetal hypoperfusion, a veno-venous cavo-caval bypass was established, allowing liver resection under total vascular exclusion without blood pressure fluctuations. The procedure was uneventful and a healthy child was delivered at term. The use of cavo-caval bypass offers a protective strategy to stabilize maternal circulation and preserve fetal well-being during major hepatectomy.

Keywords: Cavo-caval bypass; Hepatocellular adenoma; Liver surgery; Pregnancy.