Snakebite during pregnancy

Abstract

<jats:p> Little is known about snakebites during pregnancy and only a few cases have been reported in the literature. The fact that venomous snakebites during pregnancy result in high fetal wastage and may cause maternal mortality makes this an important, albeit, uncommonly encountered entity in emergency medicine. In this paper, we report on the successful treatment of three cases of snakebite in pregnancy. </jats:p>

Vipera Palaestinae Bite and Serum Sickness During Pregnancy

“…As many snake species of the Viperidae, Elaptidea, and even Colubridae families may cause coagulopathy, obstetric ultrasonographic evaluation is very important. In 3 pregnant (gestational age 18 -32 weeks) patients envenomated by Vipera species (subfamily Viperinae) in Turkey who were treated with antivenom, healthy babies were delivered at term (16). All 3 patients had local signs, one had mild thrombocytopenia (90,000 platelets/L) and one had mild prolongation of international normalized ratio (1.74) (16).…”

“…In 3 pregnant (gestational age 18 -32 weeks) patients envenomated by Vipera species (subfamily Viperinae) in Turkey who were treated with antivenom, healthy babies were delivered at term (16). All 3 patients had local signs, one had mild thrombocytopenia (90,000 platelets/L) and one had mild prolongation of international normalized ratio (1.74) (16). Two spontaneous abortions, one elective abortion, and one malformed child (reported also by Dunnihoo et al), were reported in an Israeli series of 14 snakebite victims (11,17).…”

Abruptio placentae and fetal death following a Malayan pit viper bite

“…reported a case of intrauterine fetal death after a poisonous snakebite in the first trimester of pregnancy 13 . Potential pathophysiology mechanisms accounting for abortion include the direct effects of the venom on the fetus, fetal hypoxia due to maternal shock, placental bleeding due to maternal coagulopathy, venom induced uterine contraction and pyrexia and cytokine release which occur following tissue damage 10,12,14 . Another rare mechanism of spontaneous abortion in pregnant snakebite victims is anaphylaxis resulting from antivenin (horse serum) therapy 10 .…”

“…Not only may venom have the noted abortive effects on pregnancy, but it may also cross the placenta in amounts that cause systemic poisoning of the fetus, even without evidence of envenomation in the mother 12,15 . For maternal outcome, most documented cases appear to result in significant maternal morbidity, 14,16,17 but few maternal deaths have been reported in the published work 15,18 …”

“…Antivenom is generally administered to patients with evidence of systemic or local envenomation or a distressed fetus, and to unstable patients 12,14,15,17 . However, anaphylaxis may follow its administration.…”