A Case Report of Postpartum Hemorrhage Secondary to Snake Bite Envenomation: A Pathogenesis and Current Management...

Snakebite envenomation (SBE) is a tropical disease with significant global morbidity and mortality, particularly affecting low-resource settings. During pregnancy, SBE poses unique challenges, increasing both maternal and fetal mortality. Limited access to antivenom and delayed treatment further worsen outcomes.

We report the case of a 36-year-old pregnant woman at 40.6 weeks gestation who presented to a rural Ecuadorian health center following a Bothrops snakebite to the right hand. Coagulopathy was detected and initially managed with antivenom. Because of fetal distress and oligohydramnios, an urgent cesarean section was performed. The patient subsequently developed severe postpartum hemorrhage secondary to venom-induced coagulopathy (VICC), requiring subtotal hysterectomy, intensive care, and further antivenom administration. Postoperative recovery was favorable, and the patient was discharged in stable condition.

This case illustrates the complex pathophysiology of viper envenomation, including systemic coagulopathy, uterine atony, and thrombin-induced postpartum hemorrhage. It highlights the diagnostic challenges, the limitations of standard coagulation tests in VICC, and the importance of early antivenom therapy. Delayed treatment in rural areas contributes significantly to maternal-fetal morbidity. Obstetric complications such as placental abruption, fetal hypoxia, and hemorrhage must be anticipated in SBE during pregnancy.

Timely antivenom administration and multidisciplinary management are essential to improve outcomes in pregnant patients with SBE. This case emphasizes the need for increased access to antivenom, improved diagnostic tools, and specialized obstetric care in resource-limited regions affected by venomous snakebites.