Snake Attack Victim Dies Hours After Giving Birth

A pregnant woman who rushed to hospital after a snakebite caused her to start bleeding from her vagina has died, but not before successfully giving birth to her child.

The 25-year-old woman, who was seven months pregnant, came into the emergency department of the Poli District Hospital in Cameroon after being bitten by a venomous carpet viper on her left foot only one hour prior.

She was experiencing vaginal bleeding, as well as abdominal pain and intermittent contractions, and doctors found blood in her urine and abnormal clotting in her blood before she gave birth, according to a new case-study paper in the New England Journal of Medicine.

"Although it is always important to consider pregnancy-related causes of vaginal bleeding in an otherwise healthy pregnant patient, the low platelet count and the development of coagulopathy [inability to produce clots] are the most likely explanations for this patient's bleeding," Karl Njuwa Fai, wrote in the paper.

Fai is a doctor at Cameroon's Homegrown Solutions for Health,

"Given that she reported that a snakebite had occurred approximately one hour before presentation, envenomation (poisoning by venom) is the most likely diagnosis for her bleeding disorder

The patient was given antivenom as soon as she arrived at the hospital, and then given more doses over the next few hours. However, on her third day in hospital, her vaginal bleeding and pelvic pain worsened, and it was found that she was in labor, with her cervix dilated to 5 centimeters (2 inches).

On her fourth day in hospital, she gave birth to a 7.5 pound baby boy. However, after continued bleeding, the patient was taken to the tertiary care Garoua Regional Hospital, where she was diagnosed with acute kidney failure.

"Despite aggressive treatment with antivenom and blood transfusion, four days after a snakebite by a carpet viper, the patient died," paper author and doctor at the Poli District Hospital, Hamdja Moustafa wrote in the case study.

"A combination of the systemic envenomation from a carpet viper bite and the resulting complications led to the fatal outcome in the mother. Immediate delivery of the fetus certainly played an important part in the survival of the baby," co-author Yap Boum also explained in the paper.

Boum is a doctor and executive director of the Institute Pasteur of Bangui in the Central Africa Republic,

The West African carpet viper is incredibly venomous, and is responsible for more human snakebite fatalities than all other African species combined. Bites from this species, which can measure up to 26 inches long, have a 10 to 20 percent mortality rate if untreated.

"The most venomous snake in sub-Saharan Africa, E. ocellatus, has venom composed of complex enzymes, peptides, and metalloproteinases (a form of enzyme)," Fai explained.

"Snake venom triggers a robust inflammatory response with the synthesis and release of several substances, including nitric oxide, complement anaphylatoxins, histamine, cytokines, and eicosanoids.

"These processes all lead to disseminated intravascular coagulation and may contribute to systemic bleeding."

The patient's kidney damage may have resulted from damage to the blood vessels and membranes inside the organs due to the venom.

"In addition, the effects of PLA2s on the membrane phospholipids and adenylate cyclase activity of smooth muscle of the uterus could have led to labor in this patient," Fai said.

Worldwide, around 5 million people are bitten by snakes, resulting in about 125,000 deaths and 400,000 disabilities.

"Between 2018 and 2022, Cameroon registered 40,518 snakebite cases associated with 1,056 deaths (2.6 percent). The Far North, Center, and North Regions are the most affected areas of the country, with more than 1,500 snakebite cases reported per year," Boum explained in the paper.

Snake bites in pregnancy are not common, but are usually associated with high levels of mortality for both the mother and fetus.

"Studies conducted in South Africa, Sri Lanka, and India showed that the prevalence of snakebites occurring in pregnancy ranged from 0.4 to 1.8 percent," Boum wrote.

"Although rare, they can be associated with very severe adverse outcomes, as was seen in this patient, with maternal death occurring in up to 4 percent of reported cases and fetal loss in 20 percent.

"Diverse outcomes are possible for the mother and the fetus, depending on several factors, including the type of snake and the gestational age of the fetus," Boum continued. "Fetal complications can include deformation, prematurity, and in severe cases, death."

In many cases, people bitten by snakes are unable to reach the hospital in time, or antivenoms are not available or too expensive.

"The availability and affordability of antivenom is a notable issue in Africa. It is usually difficult to obtain antivenom in the remote areas of Cameroon, where the highest number of snakebites occurs," Boum wrote.

"When antivenom is available, the cost is high ($100 to $200 per dose) for these communities, which have an average monthly income of less than $60 per person. This patient had immediate access to antivenom because the hospital was participating in a pharmacovigilance study that provided antivenom for free."

"Changes in the attitudes of international health stakeholders (e.g., community leaders, pharmaceutical companies, the Ministry of Public Health, Africa Centers for Disease Control and Prevention, and the World Health Organization) toward snakebites, universal health coverage, and local production of antivenom can go a long way in making antivenom more affordable," Boum concluded.

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