VENOMOUS ENCOUNTER: A CASE REPORT ON SNAKE BITE DURING FULL-TERM GESTATION WITH DELAYED MANIFESTATION

Background: Snake bite is uncommon among pregnant women, that too presentation in third trimester with late presentation, with envenomation is rare. Knowledge about the toxic symptoms and management of snake bite poisoning is very low due the rarity of cases.

Case report: Presenting a case of 26 year old female, Primigravida with Premature Rupture of Membranes with Snake bite in Acute Kidney Injury with Disseminate Intravascular Coagulopathy. Appropriate care and management led to the survival of both mother and baby.

Discussion: In India, 216 snake species exist, 52 are venomous. Elapids like cobras, kraits, vipers, and sea snakes pose threats. Venom potency varies with seasons and snake color. Envenomation symptoms include local pain, systemic effects, and coagulopathy. Pregnancy complicates management antivenom and careful monitoring are vital.

Conclusion: Acute kidney injury with disseminated intravascular coagulopathy arising from systemic poisoning due to snake bite in pregnancy is difficult and challenging. Obstetric and medical line of treatment depends on the severity of envenomation, gestational age at presentation, timing, duration and quality of treatment.

背景：孕妇群体中发生蛇咬伤的情况并不多见，而以妊娠晚期就诊、发病延迟且伴发中毒（envenomation）的病例更是罕见。由于此类病例较为稀少，临床医护人员对蛇咬伤中毒的毒性症状及诊疗方案的认知水平普遍偏低。
病例报告：本次报告一例26岁初产妇（primigravida）病例，该患者因蛇咬伤引发急性肾损伤（Acute Kidney Injury）合并弥散性血管内凝血（Disseminated Intravascular Coagulopathy），同时并发胎膜早破（Premature Rupture of Membranes）。经规范诊疗与护理后，产妇与胎儿均成功存活。
讨论：印度境内现存216种蛇类，其中52种为有毒蛇类。眼镜蛇科（Elapids）蛇类如眼镜蛇、银环蛇、蝰蛇及海蛇均具有致病威胁。蛇毒毒性随季节与蛇体体色存在差异。中毒症状可表现为局部疼痛、全身反应及凝血功能障碍。妊娠状态会使诊疗过程更为复杂，因此抗蛇毒血清（antivenom）的使用与严密监护至关重要。
结论：妊娠期蛇咬伤引发全身中毒，进而导致急性肾损伤合并弥散性血管内凝血的诊疗难度极高且极具挑战性。产科与内科的治疗方案需结合中毒严重程度、就诊时的孕周、治疗时机、持续时长与诊疗质量综合制定。