Snake bite in third trimester of pregnancy with systemic envenomation and delivery of a live baby in a low resource setting: A case report

Abstract

BackgroundSnake bite in the third trimester of pregnancy with late presentation, systemic envenomation; disseminated intravascular coagulopathy and delivery of a live neonate is uncommon in a low resource setting.CaseWe present a 22 year old unbooked Gravida 3 Para 1+ 1 1alive lentiviral positive woman at 32 weeks gestation with snake bite, leg swelling, vaginal bleeding and labour pains. At presentation, there were anemia, tachycardia, hypotension; a gravid uterus with a single fetus in longitudinal lie, cephalic presentation, regular fetal heart rate and cervical dilatation of 3 cm. Preterm labour with antepartum hemorrhage due to venomous snake bite was diagnosed. Multidisciplinary management instituted led to the survival of both mother and baby.ConclusionIn resource constrained setting, disseminated intravascular coagulopathy arising from systemic envenomation due to snake bite in pregnancy could be challenging. Obstetric outcome depends on the degree of envenomation, gestational age at presentation, timing, duration and quality of treatment.

Correlating Fibrinogen Consumption and Profiles of Inflammatory Molecules in Human Envenomation's by Bothrops atrox in the Brazilian Amazon

“…Among these effects, inflammatory and hemostatic disorders are frequently observed in patients. Envenomation's by viperid snakes often cause local and systemic bleeding (9,10), such as gingivorrhagia, epistaxis, hematemesis, hematuria, bleeding in the uteris, and placenta (in pregnant women) (11,12) and bleeding in the central nervous system (13)(14)(15)(16).…”

Vasculotoxic snakebite envenomation: Management challenges in pregnancy

“…1,7 Maternal complications have been reported as antepartum haemorrhage, placental abruption, preterm labour, postpartum haemorrhage, disseminated intravascular coagulation, hypotension, hypovolemic shock, anaemia, acute kidney injury and posterior reversible encephalopathy syndrome. [7][8][9][10] Reported fetal complications include miscarriage, fetal distress, intrauterine death, prematurity, hydrocephalus and polydactyly. [7][8][9][10][11] Given the dearth of literature and lack of specific obstetric guidelines, the follow-up plan of antenatal care should be individualized.…”

“…[7][8][9][10] Reported fetal complications include miscarriage, fetal distress, intrauterine death, prematurity, hydrocephalus and polydactyly. [7][8][9][10][11] Given the dearth of literature and lack of specific obstetric guidelines, the follow-up plan of antenatal care should be individualized. Our first case is unique as the time period from snakebite envenomation (eight weeks) to delivery (33 weeks and 5 days) is probably the longest reported in literature.…”

The Effects of Snake Venom (Bitis arietans) on Embryonic Development

“…Bites can be classified as cytotoxic bites characterised by a painful swelling with watery blood leaking from the wound followed by shock, blistering and discolouration. Venomous snake bites in pregnant women can lead to poor survival rates in both the foetus and mother; early bites can precipitate teratogenesis, miscarriages, preterm delivery, foetal death and antepartum haemorrhage [46]. The bite will cause severe pain to the limb affected.…”

“…These primarily occur in developing countries where there is a dense population of humans, an abundance of snakes and a lack of medical treatment facilities. In 1987 in South Africa, pregnant women accounted for 0-4% of cases admitted to hospital, in India, they accounted for 1% of admissions [46]. Venomous snakebites may lead to poor foetal development and adversely affect the mother's health; previous studies determined that foetal death occurred in 38-43% of snakebite cases, whereas maternal death accounted for 10% [69].…”