Revista Ciencias Biomédicas (Dec 2012)
Ophidic accident and twin pregnancy
Abstract
Introduction: around of 3000 types of snakes are known, from which just 15% arevenomous. Depending of the environmental, geographical and socio-demographiccharacteristics, there are significant differences in the incidence of cases of ophidicaccidents. Colombia reports 6 by each 100.000 habitants, 2.300 cases/year, with amortality of 5.6%. In a pregnant woman it is a rare event, between 1.4% and 4%, andit usually complicates seriously to the mother and to the product of the gestation. Theprevious thing will depend of the opportunity with which the suitable management isfulfilled and of the severity of the poisoning. Nowadays it isn´t clear the security of theantiophidic serum for the product, it has been related with miscarriage in early stagesof pregnancy and fetal death at the end of the pregnancy. Nevertheless, its appropriateadministration is the unique effective measure to avoid serious consequences andmaternal death.Clinical case: patient of 16 years old, G2 C1, with diagnosis of diamniotic dichorionic twinpregnancy of 36 weeks and ophidic accident of bothropic type of 16 hours of evolution.Right inferior limb with pain, edema grade III, blush, heat, formation of flictenas andecchymosis in its distal third. Laboratory tests indicate prolongation of the clotting time,elevated transaminases and elevated creatinine. It is considered the presence of severepoisoning and management with antiophidic serum is initiated. The pregnancy is finishedby cesarean as a result of maternal renal and hepatic dysfunction, and postoperativecare in UCI. The products are born with severe respiratory depression; they are carriedto neonatal intensive care unit with good evolution and hospital expenditure to thefive days. Next day to the cesarean, the patient presents compartment syndrome,for which fasciotomy is fulfilled. When the patient gets adequate recovery, it is donea cutaneous hanging tatter and after 27 days of hospitalization one gives exit withadequate recovery.Conclusion: ophidic accident in pregnancy is a rare situation, which should be managedin a fast and opportune way with the use of antiophidic serum if it is necessary andin the adequate doses. Moreover, it is a serious event with numerous immediate andbelated complications for the mother and for the fetus.Rev.cienc.biomed. 2012;3(2):333-338RESUMEN:
