Pregnant Woman Bitten by a Japanese Mamushi (<i>Gloydius blomhoffii</i>)

Abstract

We herein report the fourth case of a pregnant woman bitten by a mamushi. A 33-year-old pregnant woman in the 25th week of gestation was bitten by a mamushi. Her vital signs were stable; however, biochemical analyses of the blood showed mild deterioration of anemia and hypoproteinemia. The effects of envenomation were limited to the extremities, the administration of supportive therapy without antivenom fortunately resulted in a favorable outcome. As there are differences in the maternal medical condition and weeks of gestation, further research is needed to clarify the optimal management strategy for administering antivenom in pregnancy.

Japanese Pit Viper Bite during Pregnancy

“…Hence, the use of antivenom should be based on the type of venom and the patient’s condition. Scarce data on pregnant patients bitten by the Japanese pit viper show that all three mothers described survived without the use of antivenom, although the fetus was harmed in two of the three cases [ 2 – 4 ] . In addition, although antivenom can cause anaphylaxis and serum sicknesses, the reported rate of anaphylaxis was low in patients who received antivenom to the Japanese pit viper (0.9–1.8%) [ 5 ] ; moreover, anaphylaxis can be treated.…”

Favorable Course after a Second Infusion of Antivenin Using Premedication

“…[1] The mamushi venom mainly consists of multiple enzymes that work as hemolytic toxins, including phospholipase A2; neurotoxins, an alpha-toxin/beta-toxin; increased vascular permeability, arginine ester dehydrogenase; rhabdomyolysis, endopeptidase/bleeding factor (HR1 or HR2); platelet aggregation, L-amino acid oxidase. [2] Severe cases of mamushi bites usually require the administration of a horse-derived antivenin. [1] Basically, 6000 units of antivenin is administered immediately after the mamushi bite, and if symptoms improve, an additional 3000-6000 units is administered within a few hours.…”

“…However, the antivenin has the potential to cause anaphylaxis (3.2%) and serum diseases (11%-12%); therefore, physicians tend to hesitate to apply this treatment in mild cases. [2,3,4,5,6] Multiple exposure to antivenin might result in severe anaphylaxis. [7,8] However, there have been few reports of the treatment of such cases [8,9,10].…”