Surgical management of massive labial edema in a gravid preeclamptic diabetic.

Jennifer S Lindsey,James E Devente

doi:10.1155/2014/935267

Abstract

Background. Massive labial edema is a rare complication during pregnancy that can jeopardize vaginal delivery, as well as leading to maternal and fetal morbidity. It can be related to systemic pathologies, but has been commonly associated with preeclampsia and diabetes. This increased and sometimes longstanding pressure may result in a “labial compartment syndrome” leading to microvascular damage and tissue necrosis if not resolved in a timely fashion. Case. Massive labial edema was treated first conservatively and then surgically in a gravid diabetic patient with severe preeclampsia. Immediately after Cesarean section, the labial compartment syndrome was relieved surgically and resolved rapidly. Conclusion. When conservative attempts at management of labial edema fail, or rapid resolution is critical to maternal and fetal outcome, surgical alternatives should be considered.

Highlights

Massive labial edema is an unusual complication of pregnancy that may occur due to an underlying systemic pathology but has been associated with preeclampsia
We present a surgical alternative to conservative management of massive labial edema in a gravid, preeclamptic patient
A 21-year-old woman, gravida 2, para 1, at 32-week, gestation was transferred to our facility after initiating uterine contractions one week prior and was evaluated for uterine contractions, elevated blood sugars, and massive labial edema. Her cervical dilatation was unchanging at 1 cm and her blood sugars were labile during admission. Her history was remarkable for a recent urinary tract infection, genital warts, preeclampsia during first pregnancy, and Class C diabetes poorly managed with multiple episodes of diabetic ketoacidosis over the previous decade

Summary

Background

Massive labial edema is a rare complication during pregnancy that can jeopardize vaginal delivery, as well as leading to maternal and fetal morbidity. It can be related to systemic pathologies, but has been commonly associated with preeclampsia and diabetes. This increased and sometimes longstanding pressure may result in a “labial compartment syndrome” leading to microvascular damage and tissue necrosis if not resolved in a timely fashion. Massive labial edema was treated first conservatively and surgically in a gravid diabetic patient with severe preeclampsia. After Cesarean section, the labial compartment syndrome was relieved surgically and resolved rapidly. When conservative attempts at management of labial edema fail, or rapid resolution is critical to maternal and fetal outcome, surgical alternatives should be considered

Introduction

Case Presentation

Discussion

Findings

Ethical Approval