Background: Spontaneous hepatic rupture is a rare life-threatening event seen among patients with preeclampsia and HELLP syndrome, bringing devastating outcomes to both the woman and the baby.

Case presentation: We report a case of a 45-year-old sub-fertile primigravida following an IVF treatment with a donor embryo resulting in a DCDA twin pregnancy. She was diagnosed with pregnancy-induced hypertension at 20 weeks of gestation (POG) with DCDA twin pregnancy admitted at our hospital at 32 + 4 weeks of POG with headache, visual disturbances, vomiting and abdominal pain with severe pregnancy-induced hypertension. Category I emergency cesarean section was performed due to eclampsia, suspected placental abruption with DCDA twins with single fetal demise and acute kidney injury. During the caesarean section, the right lobe of the liver rupture was diagnosed. Even with intense multidisciplinary management, the life of this mother could not be saved, leaving behind her newborn baby with the father.

Conclusion: Due to the rarity of the entity, the unpredictable nature and the multisystemic involvement, many health care providers as well as pregnant women may not be aware of the fatal consequences of this complication.

Paladage Halgasthnnalage Sandya is a dedicated Obstetrics and Gynaecology clinician currently working as a Clinical Fellow (ST3+) at Basildon and Thurrock University Hospital, UK. She holds a Doctor of Medicine (MD) in Obstetrics and Gynaecology from the University of Colombo and has successfully completed MRCOG Part 1 and Part 2. She is fully registered with both the General Medical Council (UK) and the Sri Lanka Medical Council. Her clinical training spans a wide range of tertiary care settings in Sri Lanka, where she gained extensive experience in managing both routine and high-risk obstetric and gynaecological cases. She has a particular interest in medical disorders in pregnancy, placenta accreta spectrum disorders, and urogynaecology. She has actively contributed to teaching undergraduate students, junior doctors, and multidisciplinary teams, and is committed to continuous medical education. She has been involved in multiple audits, research projects, and international presentations, including at the RCOG World Congress. Her work has also been published in peer-reviewed journals. She is passionate about delivering safe, evidence-based care and continuously improving clinical outcomes through research, audit, and reflective practice.