The venom bites in pregnant women: systematic review

Abstract

Abstract Background The snakebite in pregnancy are rarely reported in literature; they cause mortality and morbidity, the symptoms may be many, such as circulatory collapse, respiratory failure, bleeding, renal failure. The antivenom is the standard treatment, but it can be a potential cause of anaphylaxis and serum diseases; its effects on the fetus are unknown, so doctors may hesitate to apply it. We conducted this study because there are many cases not described in the literature also in Italy. The aim of systematic review is to evaluate the outcomes of the bites for women and newborns and the antivenom treatments in pregnant women, to understand the best behaviour to adopt. Methods In January-February 2020, we searched studies in Medline using the key MeSH Terms “snake bites” and “pregnant woman”. We included all case-control studies and letter to editor in English. Results The research yielded 22 publications: after title, abstract and full text's analysis, 12 manuscripts were included in this review. The studies were conducted from 2006 to 2019 in Japan, Taiwan, India, Pakistan, Thailand, Burkina Faso, USA, Israel and included a total of 14 pregnant women (1-3 women per study). The mean age was 30.47± 7.34, the average of pregnancy week was 21.50±11.25, 93.33% of mothers was alive as well as 60% of fetuses. The antivenom was given in 66.67% of cases, of these, all mothers were alive and only four newborns were dead (the deaths in studies don't seem to be related to the use of antivenom). Conclusions Snakebite during pregnancy could lead to serious complications for mother and fetus. The use of antivenom does not appear to be related to fetal or maternal death, and it should always be species-specific for the type of snake, so as to reduce the risk of adverse effects caused by antivenom or its improper use. It is necessary to implement guidelines for the correct management of therapy and to ensure good maternal and fetal outcomes. Key messages It is important to diagnose snakebite in pregnant women quickly in order to begin supportive therapy and identify the species of snake for the administration of the correct antivenom. An improvement of the guidelines is needed for better management of therapy in pregnant women.