Torrential epistaxis in the third trimester: a management conundrum

Area of Science:

• Obstetrics & Gynecology
• Otolaryngology

Background:

• Epistaxis (nosebleed) is common in pregnancy, but large-volume bleeding is rare.
• Standard epistaxis management options may be contraindicated or carry risks during pregnancy.
• Ear, nose, and throat surgeons require knowledge of safe and effective interventions for pregnant patients.

Observation:

• A 32-year-old woman at 32 weeks gestation presented with severe epistaxis unresponsive to conservative treatment.
• Interventions like bismuth iodoform paraffin paste (BIPP) and Floseal were deemed unsuitable due to contraindications or risks in pregnancy.
• Unorthodox management strategies were necessary.

Findings:

• The case highlights alternative approaches for managing severe epistaxis in pregnancy.
• Discusses differential diagnoses and relevant investigations for this condition.
• Emphasizes the need for tailored management strategies when standard treatments are not viable.

Implications:

• Provides valuable insights for clinicians managing complex epistaxis cases in pregnant women.
• Contributes to the understanding of safe and effective epistaxis treatment protocols during gestation.
• Underscores the importance of adapting surgical techniques and management plans for obstetric patients.